DER INSULINHYPOGLYKÄMIE-TEST ALS FUNKTIONSPRÜFUNG DES HYPOTHALAMUS-HYPOPHYSEN-NEBENNIERENRINDEN-SYSTEMS.

Abstract

In 22 subjects determinations of blood sugar and plasma corticosteroids (11-OHCS) were carried out before and during insulin-induced hypogly-caemia. In 17 of these patients (free from endocrine disorders) whose blood sugar fell below 45 mg/100 ml a distinct increase in plasma concentrations of 11-OHCS was noted. The mean maximal increase was found to be 13.1 [plus or minus] 3.7 [mu]g/100 ml (range: 6.4-19.6 [mu]g/100 ml). At sixty minutes p.i. the mean value of 11-OHCS was 25.3 [plus or minus] 4.3 [mu]g/100 ml. Of another 5 patients (2 with diabetes mellitus) where the blood sugar did not fall below 50 mg/100 ml 4 showed no increase in plasma corticosteroids. In order to effect an increase, in healthy subjects an insulin dose of 0.15 U/kg body weight is recommended. The increase of corticosteroid levels in plasma during hypoglycaemia is considered to be the consequence of stress-induced stimulation of the hypothalamo-pituitary-adrenal axis. This mechanism provides the base of the test in the detection of hypothalamic or pituitary disturbances (hypoglycaemia-test). The pathophysiological significance of this test is compared with that of the metopiron-test and its advantages over the pyrogen-test discussed.