Аннотация:Hypothalamic-pituitary-adrenal (HPA) function was examined by metyrapone and insulin hypoglycemia tests in narcotic addicts on a methadone substitution regimen, apparently free from heroin. Normal resting 24-hr urinary 17-ketogenic steroids rose normally in 14/15 subjects after metyrapone administration and in all 15 subjects after exogenous ACTH. Base line plasma 17-OH-corticosteroids (cs) were normal and rose normally after adequate insulin- induced hypoglycemia in 8/9. Comparison of 4 pm with 9 am plasma 17-OH-cs showed a normal nycthemeral pattern in only 6/16, while another 6/16 actually displayed a reversal of the normal afternoon fall. Although interference with the hypothalamic pituitary nycthemeral periodicity may occur in methadone-treated heroin addicts, their feedback (metyrapone) and stress (insulin hypoglycemia) mechanisms regulating HPA function appeared to operate normally. Heroin addicts, not on methadone, displayed normal resting plasma 17-OH-cs which increased after insulin. Quantitatively normal responses were evident in 5/8; the small rise in 2 others may have been a reflection of an insufficient hypoglycemic stimulus.
