Probable Hypothalamic Disorder Requiring Corticoid Therapy in Patients with Pituitary Adenoma or Craniopharyngioma

From findings in six patients with pituitary adenoma or craniopharyngioma correlations were sought between (a) radiological and other evidence of anatomical suprasellar or intrasellar disturbance and (b) clinical and laboratory indicators of pituitary function. Two patients with grossly enlarged sellae (most of the contents of the pituitary fossa had been removed in one) had essentially normal hypophyseal function. Two others with no sellar enlargement had disabling hypopituitarism. The need for corticoid therapy was not associated with impairment of (1) urine 17-hydroxycorticoid (17-OH) response to intravenous ACTH in two patients, (2) RAI uptake in two and (3) PBI in three. There was no 17-OH response to oral methopyrapone (750 mg. every four hours for six doses) in all four cases requiring corticoids for hypopituitarism. Four control subjects showed 17-OH levels of 12 to 18 mg. per day (twofold to threefold rises above baseline) on the day after methopyrapone was given. In no instance was the urine concentrating ability impaired remarkably. The suprasellar effects of such tumours are more often responsible for anterior pituitary deficiency than is generally recognized. Methopyrapone offers desirable sensitivity and specificity in the testing of pituitary function.