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<p>Adrenal insufficiency (AI) may lead to a&#xa0;variety of symptoms, whereby severe forms constitute a&#xa0;life-threatening condition with catecholamine-resistant hypotension, hyperkalaemia, and coma. While the diagnosis of severe AI is based on clinical symptoms, fasting morning cortisol, and ACTH levels, the diagnosis of more ambiguous manifestations relies on functional tests based on hypothalamic-pituitary-adrenal (HPA) axis stimulation. The overnight metyrapone test (OMT) represents a&#xa0;method for outpatient evaluation of hypocortisolism. Especially in cases with a&#xa0;high pre-test probability, OMT is an effective and safe diagnostic method. In the following, indication of OMT and test principles, performance, and associated pitfalls will be addressed.</p>

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Abklärung bei adrenaler Insuffizienz

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月29日

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  • Clemens Baumgartner,
  • Peter Wolf

摘要

Adrenal insufficiency (AI) may lead to a variety of symptoms, whereby severe forms constitute a life-threatening condition with catecholamine-resistant hypotension, hyperkalaemia, and coma. While the diagnosis of severe AI is based on clinical symptoms, fasting morning cortisol, and ACTH levels, the diagnosis of more ambiguous manifestations relies on functional tests based on hypothalamic-pituitary-adrenal (HPA) axis stimulation. The overnight metyrapone test (OMT) represents a method for outpatient evaluation of hypocortisolism. Especially in cases with a high pre-test probability, OMT is an effective and safe diagnostic method. In the following, indication of OMT and test principles, performance, and associated pitfalls will be addressed.