Metyrapone Ditartrate (Metopirone) Test During Ganglio-Pulmonary Sarcoidosis of Besnier-Boeck-Schaumann

Diagnostic and Etiopathogenic Value

¹ Lyon, France

The systematic study of the metyrapone ditartrate (Metopirone) test response, in an endocrinology department, permits us to establish the constant negativeness of results, except in some cases with endocrinopathies. In 120 tests, there were four positive responses indicating pituary hyperfunction and 25 responses which revealed pituitary hypofunction.

In the Pneumo-Phthisiology Clinic of the Faculty of Lyon, where this test was carried out over a period of two years on a series of 50 non-sarcoidosis patients, all the tests were negative, as concerned a pituitary hyperfunction with the exception of one case of pulmonary neoplasm.

On the contrary, in the series of cases with gangliopulmonary disease of sarcoid origin, there was a high frequency of neuro-pituitary hyperactivity symptoms related to the development of the disease in its endothoracic ganglionary, miliary or infiltrative forms.

Our findings can be summarized in the following manner:

(1) Recent untreated forms—14 cases.

The test was positive in 11 cases (78.5 per cent) at rates which were occasionally very high. The highest rate was a urinary elimination of 68.4 mg. per 24 hours of 7-OH and 64.57 mg. per 24 hours of H₄S. One of the negative cases must be ignored because the test was carried out during the subject's menstrual period.

All the cases treated with cortisone were followed and it was observed that the test tended to normalize as the lesions diminished. The test was carried out ten days after the termination of corticotherapy.

In eight cases (75 per cent) the test returned to normal at the same time that the lesions completely regressed. In two cases in which the lesions did not completely clear, the test showed a tendency to normalize, but the stabilization was only pertial.

(2) Old stabilized forms—13 cases.

In 12 completely stabilized or cured cases, the test was found normal. In the 13th case, in which the disease was of ten years' duration, there was a pulmonary infiltrative relapse and the test was positive at 34.47 mg. of H₄S.

These findings convincingly varified can open new horizons on the disease and the effects of treatment. It is possible that cortisone acts only as an inhibitor of abnormal or excessive secretions of pituitary origin. As for the syndrome of pituitary hypofunction usually encountered in diabetes insipidus and which is contrary to the facts just reported, it is possible that it occurs secondarily, after a period of initial hyperactivity which has not yet been recognized.