stimulation test
According to kaplan
Metyrapone is a Stimulation test, (just like Insulin induced hypoglycemia)
lets start from begining how v will diagnose adrenal insufficiency
1-
RAPID ACTH STIMULATION TEST
(page 277 of kaplan green physiobook)
outcome
a- increase cortisol------->Normal
b- no change in cortisol------->Hypocortisolism
(primary/secondary, v have to investigate further)
2-
METYRAPONE TESTING / INSULIN INDUCED HYPOGLYCEMIA
outcome
a-
MORE increase ACTH, increase deoxycortisol, decrease cortisol
{PRIMARY}
b-decrease ACTH, decrease deoxycortisol, decrease cortisol
{SECONDARY
3-DEFINATIVE TEST ACTH (PAGE 280 KAPLAN physio)
outcome
a-increase ----->PRIMARY
b-decrease----->SECONDARY
how deoxy still increase as v r overstimulating it by metyrapone(this means that some reseve r still there which come out by metyrapone

now ur question y not ACTH from start , that is something i m missing too, lets c someone else can help us out

and thanks for putting conceptual questions, u make me think deep:happy: