metyrapone test | allina cheers (2023)

How is the test performed?

A venous blood sample and a 24-hour urine sample can be taken for this test.

Methods for collecting a sample for this test vary. Depending on the method used, you may need to collect a sample more than once, over several days, or at specific times. Ask the health worker to explain the details of this test to you.

Venous blood:

If a blood sample from a vein is needed, a vein in the arm is usually chosen. A tourniquet (large rubber band) may be placed over the vein. The skin over the vein is cleaned and a needle is inserted. You will be asked to remain very still while the blood is being drawn. Blood is collected in one or more tubes and the tourniquet is removed. When enough blood has been collected, the health worker removes the needle.

24-hour urine collection:

For a 24-hour urine collection, all urine voided within 24 hours must be collected. When you are in the hospital, a medical worker will collect your urine. When taking the sample at home, you will be given a special container to collect the sample. The following are instructions for collecting a 24-hour urine sample at home:On the morning you are supposed to start collecting urine, urinate in the toilet and discard the first urine that comes out. Note the date and time. This is the date and time the collection begins.Collect all of the urine that you pass, day and night, for 24 hours. Use the container you were given to collect urine. Avoid using other containers. The urine sample should include the last urine passed 24 hours after the start of the collection. No toilet paper, stool or anything else should be added to the urine sample.Record the date and time of the last sampling.The urine sample may need to be kept cool during the 24 hour collection period. If so, keep the container sealed in a pan with ice. Do not put ice in the container with the urine.

How should I prepare for the exam?

Depending on the method used for this test, you may need to take medication the night before the test. Ask your healthcare professional for information about preparing for this test, including when to take any medication.

Let the person doing the test know if you are pregnant[7].

Venous blood:

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Before you have your blood drawn, tell the person who will draw your blood if you are allergic to latex. Tell your doctor if you have a medical condition or are taking any medication or supplement that causes excessive bleeding. Also tell the health worker if you have felt sick, dizzy or faint during a blood draw in the past.

24-hour urine collection:

During a 24-hour urine collection, follow your usual diet and drink fluids as you normally would unless otherwise directed by medical personnel. Avoid alcohol before and during urine collection.

How will the exam be?

The level of discomfort you experience depends on many factors, including your sensitivity to pain. Communicate how you are feeling with the person taking the test. Tell the person taking the test if you feel you cannot continue with the test.

Venous blood:

During a blood draw, you may experience a slight discomfort at the site where the blood sample is taken.

24-hour urine collection:

This test does not usually cause any symptoms.

What are the normal results for this test?

Ask your doctor about the normal results of this test.

Normal values ​​are indication-, patient- and technique-specific [3][6][2].

(Video) Surgical Management of Cushing's Disease

What are other names for this test?

  • Metopiron-Stimulationstest
  • Panel de Metirapona
  • Metyrapon-Stimulationstest

What are related tests?

  • Serum cortisol measurement
  • Dexamethason-Suppressionstest
  • Serum measurement of 11-deoxycortisol
  • ACTH measurement in serum

What are the risks?

Sangre:During a blood draw, you may bruise (a blood-filled bump under the skin) or bleed slightly at the puncture site. After a blood draw, bruising or infection may occur at the puncture site. The person performing this test may need to perform it more than once. Talk to your healthcare professional if you have concerns about the risks of this test.

Urine:A urine test is generally considered safe. Talk to your healthcare professional if you have any questions or concerns about this test.

What should I do after this test?

Ask your doctor how you will be notified of the test results. You may be asked to request the results, make an appointment to discuss the results, or be notified of the results by mail. Follow-up care depends on many factors related to your test. Sometimes there is no follow-up after you have been notified of the test results. At other times, follow-up may be suggested or required. Some examples of follow-up include changes in medication or treatment plan, referral to a specialist, more or less frequent monitoring, and additional tests or procedures. Talk to your healthcare professional about any concerns or questions you have about follow-up care or directions.

What is this test?

This test measures levels of steroid hormones, 11-deoxycortisol, cortisol, and adrenocorticotropic hormone (ACTH) in the blood. This test also measures the levels of byproducts of these hormones in the urine. This test is done after taking a dose of metyrapone, a drug that decreases cortisol production. It is used to assess the pituitary gland's ability to produce ACTH in response to a drop in cortisol levels. This test is used when there is a suspicion of an ACTH-producing tumor, Cushing's syndrome or adrenal insufficiency[1][2][3][4][5][6].

What could affect my test results?

Application of drug therapy:

Some medicines can affect the test results. These drugs include:

  • Fosphenytoin (injection route, solution, injection)
  • Phenytoin (oral, capsule, extended-release capsule, suspension, tablet, chewable tablet)
  • Phenytoin (Injection Route, Intravenous Use, Solution, Kit)
  • Estradiol (oral, tablets)
  • Estradiol (Transdermaler Weg, Emulsion, Gel/Yellow, Aerosol)
  • Estradiol (vaginal, cream, insert, extended release, tablet)
  • Estradiol (intramuscular route, oil)
  • Estradiol patches (transdermal route, patch, extended release)

What should I do after the test?

Venous blood:

After a sample of blood is drawn from your vein, a bandage, cotton ball, or gauze pad may be placed on the area where the needle was inserted. You may be asked to put pressure on the area. Avoid strenuous exercise immediately after blood collection. Contact your doctor if you experience pain, redness, swelling, or discharge at the injection site.

24-hour urine collection:

When the 24-hour urine collection is complete, close the container and secure the lid tightly. Return the sample in the urine container to the facility or medical staff as instructed. If you had the sample in an ice bath, return it within two hours of removing the container from the ice bath.

When and how often should I take this test?

When and how often laboratory tests are performed can depend on many factors. The timing of laboratory tests may depend on the results or completion of other tests, procedures, or treatments. Laboratory tests can be done immediately in an emergency, or tests can be delayed while a condition is being treated or controlled. Testing may be recommended or necessary if certain signs or symptoms appear.

Because of changes in the way your body works naturally throughout the day, laboratory tests may need to be run at a specific time of day. If you have prepared for a test by changing your food or fluid intake, lab tests can be scheduled according to those changes. The timing of tests can be based on rising and falling levels of medication, drugs, or other substances in the body.

The age or gender of the person being tested can affect when and how often a lab test is required. Chronic or progressive disease may require continued monitoring through the use of laboratory testing. Conditions that worsen and improve may also need frequent monitoring. Certain tests may be repeated to obtain a range of results, or repeat tests may be required to confirm or disprove results. The timing and frequency of laboratory tests may vary if they are performed for professional or legal reasons.

Depending on the method used for this test, blood or urine may need to be collected more than once, over several days, or at specific times. Talk to your healthcare professional about when and how often you need to have this test.

Where can I get more information?


  • National Adrenal Gland Foundation -

related medicines

  • Tartrato de metirapona

Why do I need this test?

Laboratory tests can be performed for many reasons. Tests are performed for routine health screening or when disease or toxicity is suspected. Laboratory tests can be used to determine if a medical condition is improving or worsening. Laboratory tests can also be used to measure the success or failure of a medication or treatment plan. Laboratory tests may be ordered for professional or legal reasons. You may need this test if you:

  • Adrenal Cushing's Syndrome
  • adrenal insufficiency
  • adrenal tumor

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What does metyrapone test for? ›

The test is performed primarily to detect partial defects in pituitary ACTH secretion.

What hormone level is suppressed by metyrapone? ›

The initiation of metyrapone paradoxically decreased plasma adrenocorticotropic hormone (ACTH) levels and suppressed cortisol levels.

What test confirms Cushings? ›

The dexamethasone-CRH test shows whether excess cortisol is caused by Cushing's syndrome or by something else. Some people have high cortisol levels off and on but don't develop the long-term health effects of Cushing's syndrome.

How is Cushing's disease diagnosed? ›

Diagnosis of Cushing's syndrome is based on a review of your medical history, physical examination and laboratory tests, which help to determine the presence of excess levels of cortisol. Often X-ray exams of the adrenal or pituitary glands are useful for locating tumors.

What hormone is elevated in Cushing's syndrome? ›

Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication.

What hormones are high in Cushing's? ›

Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body.

How does metyrapone treat Cushing's? ›

Medical Treatment of Cushing's Disease

Metyrapone inhibits cortisol synthesis through inhibition of 11β- and 18β-hydroxylase activity [41]. Metyrapone is rapidly effective and can lead to cortisol reductions within a few hours of the first dose.

Does high cortisol always mean Cushing's? ›

Some people have an abnormal amount of cortisol that is caused by something unrelated to Cushing's syndrome such as polycystic ovarian syndrome, depression, pregnancy, and obesity. This is called pseudo-Cushing state.

Can you still have Cushings with normal cortisol levels? ›

Clinical and laboratory features of Cushing's syndrome have been reported in rare cases with low, undetectable, or normal cortisol levels,45,46 as we also observed in one of our patients.

What are three symptoms of Cushing's syndrome? ›

Symptoms of Cushing's Syndrome include:
  • Weight gain, especially in the upper body.
  • Rounded face and extra fat on the upper back and above the collarbones.
  • High blood sugar (diabetes)
  • High blood pressure (hypertension)
  • Thin bones (osteoporosis)
  • Muscle loss and weakness.
  • Thin, fragile skin that bruises easily.
Jan 24, 2022

How do you feel when you have Cushing's disease? ›

People with Cushing's syndrome may see their face get round ("moon face"), they gain weight in unusual ways, bruise easily or feel weak, tired and sad. Women and men may also notice fertility and other problems. CS is most often found in adults between the ages of 20 and 50.

What is the first test for Cushing syndrome? ›

Three first-line diagnostic tests are currently used to screen for CS: measurement of free cortisol in 24-hour urine (UFC), cortisol suppressibility by low doses of dexamethasone (DST), and assessment of cortisol circadian rhythm using late-night serum and/or salivary cortisol.

How do you fix Cushing's disease? ›

Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove the tumor or the pituitary or adrenal glands. Other treatment may include radiation, chemotherapy, and use of certain hormone-inhibiting drugs.

Which test is used to differentiate Cushing's syndrome from Cushing's disease? ›

The Dex–CRH test as well as a single measurement of cortisol in serum or saliva at late (mid-) night demonstrated high diagnostic accuracy in differentiating PCS from true CD.

How does Metyrapone treat Cushing's? ›

Medical Treatment of Cushing's Disease

Metyrapone inhibits cortisol synthesis through inhibition of 11β- and 18β-hydroxylase activity [41]. Metyrapone is rapidly effective and can lead to cortisol reductions within a few hours of the first dose.

Which test is done to diagnose Addison's disease or Cushing's disease? ›

ACTH stimulation test.

ACTH tells the adrenal glands to make cortisol. This test measures the level of cortisol in the blood before and after a shot of human-made ACTH .

What is elevated in Cushing's syndrome? ›

Too much of the hormone cortisol in your body causes Cushing syndrome. Cortisol, which is produced in the adrenal glands, plays a variety of roles in your body. For example, cortisol helps regulate your blood pressure, reduces inflammation, and keeps your heart and blood vessels functioning normally.


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