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Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications
ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110

RESEARCH ARTICLE

www.ijera.com

OPEN ACCESS

Mathematical Model for the Effects of Age and Gender on
Pituitary – Adrenocortical Responsiveness in Humans
Dr. S. Lakshmi* and N. Durgadevi**
* Principal, Government Arts and Science College, Peravurani, Thanjavur District
** Research Scholar of Mathematics, K.N.Govt. Arts College for Women, Thanjavur.

ABSTRACT
In the present paper, we discuss the methods of determining the reliability of the system, when we have
information on the reliability of its subsystems (or) components. The reliability function is a function of time,
R(t), 0 < t < ∞. The time t is fixed at a given value say t0. So, we express the reliability of the system, Rsys as a
function ψ( R1, R2, ……….. Rn. ) of the reliability values of its subsystems. In the application part we
consider, the human system and HPA as its sub system. The values for cortisol and ACTH for young men,
oldmen, young women, old women are compared (i) when CRH alone is administered (ii) when CRH + AVP
combined is administered. MTTF values are obtained for all the four cases. Even though, the time is small, the
fractions show a high degree of intraindividual constancy overtime which proves the medical report. The results
in medical model suggest that at least in men, an impaired feed back inhibition of pituitary adrenal secretory
activity contributed to the age induced increment in pituitary adrenal responsiveness.
Keywords : Cortisol, ACTH, CRH, CRH / VP.
2010 AMS Classification: 62HXX, 60 EXX

I.

MATHEMATICAL MODEL

We discuss methods of determining the
reliability of a system when we have information on
the reliability of its subsystems or components and we
know the structure of the system. The reliability is a
function of time R(t), 0 < t < .
Consider a system having two components
C1 and C2. We say that the two components are
connected in series if the failure of either one of
components causes an immediate failure of the
system.
Let Ii (i = 1, 2) be an indicator function,
assuming the value Ii = 1 if component Ci operates
throughout the specified period [0, t0), and Ii = 0
otherwise. The system operates through the period [0,
t0) if and only if I1I2 = 1; We therefore define the
series structure function,
s(I1, I2) = I1 . I2
(1.1)
Both I1 and I2 are random variables and E{Ii}= Pr { Ii
=1}= Ri, where E{.}denotes the expected value and Ri
is the reliability of Ci, i = 1, 2. Notice that s (I1, I2)
assumes only the value 0 (if the system fails) or 1 (if
the system survives). The reliability of the system is
Rsys = Pr{s(I1, I2) = 1}
 (1.2)
= Pr{ I1 = 1; I2 =
1}
But due to the independence of I1 and I2,
Pr{ I1 = 1, I2 = 1}= Pr{ I1 = 1}Pr { I2 = 1}
Hence
Rsys = R1. R2
(1.3)
Thus, if we define the function s(x1,x2)=x1.x2, for all
x1,x2 in [0,1]
Then
www.ijera.com

Rsys = Pr{s (I1, I2)=1}
=s(R1,R2)

(1.4)
We can extend this result to a system of n independent
components connected in series. Thus, let
n

s(x1,…..xn) =

 xi
i 1

(1.5)

for all xi in [0,1], where
n

 ai = a1, a2, … an
i 1

Then
Rsys = Pr {s(I1,I2,I3…In)=1}
= R1R2 …. Rn

(1.6)
= s (R1,, …

Rn)
Notice that if T1,…. Tn are the actual failure times of
the n components, then the failure time of a system
connected in series is
Ts = min Ti
1  i
n
A system of two components, C1 and C2 is
connected in active-parallel if the system fails only
when both components fail. The parallel structure
function is
p (x1,x2) = 1 – (1 – x1) (1 – x2)
 (1.7)
0  x1, x2  1. In terms of the indicator functions I1
and I2,
p (I1,I2)= 1 – (1 – I1) (1 – I2) = I1 + I2 – I1 I2  (1.8)
2107 | P a g e
Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications
ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110
Thus p (I1, I2) = 0 iff both I1 = 0 and I2 = 0. In this
case, if I1 and I2 are independent,
Rsys = Pr {p (I1, I2) = 1}= 1 – E {1 – I1} E {1 – I2}
= 1 – (1 – R1) (1 – R2) = p (R1, R2)
If the system is comprised of n independent
components, connected in active parallel, then
n

Rsys = p (R1,….Rn) = 1 -

 (1 – Ri)
i 1

When Cortisol (100µg CRH alone) is given to
youngmen ,
Rsys = 1- [(1- R1) (1 – R2) (1 – R3) (1 – R4) (1 – R5) (1
– R6)]
Rsys = 0.9999
Similarly, for other cases also Rsys = 0.9999

II.

APPLICATION

Aging appears to be accompanied by a
progressive disturbance of the hypothalamus pituitary
– adrenal (HPA) system which is the most important
mediator of the neuro-endocrine response to stress
[12]
However there is growing evidence from
animal studies that age-dependent dysfunctioning of
the HPA system is not restricted to the hippocampus
and hypothalamus but occurs also at the pituitary

Plasma cortisol (left) ACTH (right)
concentrations prior to and after stimulation with
100μg of human corticotropin releasing hormone
(hCRH) alone (upper panels) and a combination of

www.ijera.com

www.ijera.com

level. Also, two human studies have reported [7,8] on
a tendency towards enhanced peak ACTH and cortisol
concentrations following administrative of ovine CRH
in healthy elderly compared to younger controls.
Contrasting with the rather inconsistent
findings after stimulation solely with CRH,
substantially elevated responses of ACTH and cortisol
were found in the healthy elderly when stimulated
with a combined bolus injection of hCRH and
vasopressin (VP) [2].
Vasopressin is besides CRH, the most
important secretgogue for ACTH [1,3,13]. Hence, the
combined administration of both peptides appears to
be more physiological test of pituitary-adrenal
functioning.
The effect of gender on pituitary adrenal
activity is even less well investigated than that of age,
although a distinct dependency on the sex is well
known for the release of some other pituitary
hormones [4]. Thus, in humans cortisol secretion
during the 24-h cycle did not differ significantly
between the sexes, but ACTH secretion was higher in
men than in women [4]. The present study aimed to
distinguish the effects of age and gender on pituitaryadrenal responsiveness to hCRH alone and to a
combined injection of hCRH and Vasopressin

hCRH (100 μg) and arginine vasopressin (VP 0.5 IU);
lower panels: (a) in young (thick solid) and old men
(thin solid) (b) in young (thick dashed) and old women
(thin dashed)

2108 | P a g e
Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications
ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110

III.

MATHEMATICAL RESULTS

By

using

the

formula

R(t)

www.ijera.com

young women

=



  t  t0  
  , t  t0
    



1.2

exp   

1

R(t)

0.8

We get the following figures

CRH Cortisol

0.6

ACTH

0.4

Young Men

CRH/ VP Cortisol
0.2

1.2

ACTH

0

1

1

2

3

5

6

Time

0.8
R(t)

4

CRH Cortisol

0.6

ACTH

0.4

CRH/VP Cortisol

0.2

Old women

ACTH

0

1.2

1

2

3

4

5

6

1

Time
R(t)

0.8

CRH Cortisol

0.6
0.4

Old men

ACTH

0.2

CRH / VP Cortisol
ACTH

0

1.2

1

2

3

4

5

6

1

Time
R(t)

0.8

CRH Cortisol

0.6

ACTH
0.4

CRH/VP Cortisol
ACTH

0.2

0
1

2

3

4
Time

www.ijera.com

5

6

IV.

MEAN TIME TO FAILURE
FUNCTION

MTTF = t0 + θ


1
 1  
 



2109 | P a g e
Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications
ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110
MTTF values for young men
Group
Cortisol

[2]

ACTH

CRH

3.9723

4.8694

CRH + VP

3.9740

4.1321

MTTF values for old men
Group
Cortisol

[3]

ACTH

CRH

4.001

4.2098

CRH + VP

4.0209

4.054

MTTF Values for young women
Group
Cortisol

[4]

ACTH

CRH

3.9883

4.58

CRH + VP

3.9923

4.1335

MTTF values for old women
Group
Cortisol

ACTH

CRH

4.0187
4.0138

3.9572

[6]

3.9577

CRH + VP

[5]

V.

CONCLUSION

The reliability to test the effect of cortisol
and ACTH are measured and compared with the
mathematical model. Basal secretion of cortisol did
not differ among groups. But basal concentrations of
ACTH were diminished in young women. Pituitary
responses to hCRH did not differ between young
men and women. However , responses to hCRH/VP
were stronger in the younger females. Pituitary –
adrenal secretory responses were greater in old than
in young men after sole injuction of hCRH and even
more so after combined injection of hCRH/VP. In old
women, pituitary adrenal secretory responses were
also greater than in young women. But, in particular
for responses to hCRH/VP, the effects were less
distinct than within the men. From the mathematical
model, the values for cortisol and ACTH for young
men, old men,. young women, old women are
compared (i) when CRH alone is administered . (ii)
when CRH and AVP combined is administered.
MTTF values are obtained for all the four cases. Even
though the time is small, the fractions show a high
degree of intra individual constancy overtime,which
proves the medical report. The results in medical
model suggest that atleast in men, an impaired feed
back inhibition of pituitary adrenal secretory activity
contributed to the age induced increment in pituitary
adrenal responsiveness.[9,10,11]

REFERENCES
[1]

Axelrod J . Reisine TD. Stress hormone: their
interaction and regulation . Science 1984:
224:452- 459

www.ijera.com

[7]

[8]

[9]

[10]

[11]

[12]

[13]

www.ijera.com

Dodt C.Dittmann J . Hruby J. Spath-Schwalbe
E. Born J. Schutler
R. et al. Different
regulation of adrenocorticotropin and cortisol
secretion in young. Mentally healthy elderly
and patients with senile dementia of
Alzheimer’s type. J Clin Endocrinol Metab
1991:72:272-276.
Familari M. Smith AI. Funder JW, Arginine
vasopressin is a much more potent stimulus to
ACTH release from ovine anterior pituitary
cells than ovine corticortropin releasing factor.
Neuro endocrinology 1989:50:152-157
HO KY. Evans WS. Blizzard RM. Effects of
sex and age on the 24 hour profile of hormone
secretion in man: importance of endogenous
estradiol concentrations. J Clin Endocrionol
Mctab 1987: 64:51-58
Lakshmi. S and
Shanmaga priya.S,
Mathematical model for the Corticosteroid feed
back effects on ACTH secretion
in
hypoadrenocorticism . Acta Ciencia Indica,
2008 Vol . XXX IV M, No.4 1767
Lakshmi.S and Senthil Kumar. P Stochastic
model for cortisol secretion due to human stress
in journal of Indian Acad Math,(2007) Vol 29,
No. 2 PP. 313-321
Ohashi M. Fujio N. Kato K. Nawata H.
Iharyashi H. Aging is without effect on the
pituitary – adrenal axis in men . Gerontology
1986:32:335-339 .
Pavlov EP. Harman SM. Chrousos GP. Loriaux
DI,. Blackman MR . Responses of plasma
adrenocorticotropin.
Cortisol.
and
dehydroepiandrosterone to ovine corticotropinreleasing hormone in healthy aging men. J Clin
Endocrinol Metab 1986:62:767-772.
Reul JMHM. Rothuizen J. DeKloet ER. Agerelated changes in the dog hypothalamicpituitary
–
adrenocortical
system:
Neuroendocrine activity and corticosteroid
receptors. J
Steroid
Biochem
Mol
Bio1991:40:63-69.
Sapolsky RM. Krey LC. McEwen BS.The
neuroendocrinology of stress and aging: the
glucocorticoid cascade hypothesis. Endocr Rev
1986:77: 284-304
Sapolsky
RM, Krey LC. McEwen BS.
Glucorticoid sensitive hippocampal neurons are
involved in terminating the adrenocortical
stress response.Proc Natl Acad Sci USA
1984:81: 6174-6177 .
Selye H. Tuchweber B. Stress in relation to
aging and disease. In Everitt A. Burgaes J.
editors. Hypothalamus. pituitary and aging .
Springfield.II: Charles C Thomas 1976:557-573
.
Spath - Schwalbe E. Fehm HL. Born J. Pfeiffer
EF. Combined corticotropin releasing hormone
vasopressin test: a new test for the evaluation of
the pituitary adrenal system. Horm Metab Res
1987: 19: 665-666.

2110 | P a g e

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Mi3621072110

  • 1. Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110 RESEARCH ARTICLE www.ijera.com OPEN ACCESS Mathematical Model for the Effects of Age and Gender on Pituitary – Adrenocortical Responsiveness in Humans Dr. S. Lakshmi* and N. Durgadevi** * Principal, Government Arts and Science College, Peravurani, Thanjavur District ** Research Scholar of Mathematics, K.N.Govt. Arts College for Women, Thanjavur. ABSTRACT In the present paper, we discuss the methods of determining the reliability of the system, when we have information on the reliability of its subsystems (or) components. The reliability function is a function of time, R(t), 0 < t < ∞. The time t is fixed at a given value say t0. So, we express the reliability of the system, Rsys as a function ψ( R1, R2, ……….. Rn. ) of the reliability values of its subsystems. In the application part we consider, the human system and HPA as its sub system. The values for cortisol and ACTH for young men, oldmen, young women, old women are compared (i) when CRH alone is administered (ii) when CRH + AVP combined is administered. MTTF values are obtained for all the four cases. Even though, the time is small, the fractions show a high degree of intraindividual constancy overtime which proves the medical report. The results in medical model suggest that at least in men, an impaired feed back inhibition of pituitary adrenal secretory activity contributed to the age induced increment in pituitary adrenal responsiveness. Keywords : Cortisol, ACTH, CRH, CRH / VP. 2010 AMS Classification: 62HXX, 60 EXX I. MATHEMATICAL MODEL We discuss methods of determining the reliability of a system when we have information on the reliability of its subsystems or components and we know the structure of the system. The reliability is a function of time R(t), 0 < t < . Consider a system having two components C1 and C2. We say that the two components are connected in series if the failure of either one of components causes an immediate failure of the system. Let Ii (i = 1, 2) be an indicator function, assuming the value Ii = 1 if component Ci operates throughout the specified period [0, t0), and Ii = 0 otherwise. The system operates through the period [0, t0) if and only if I1I2 = 1; We therefore define the series structure function, s(I1, I2) = I1 . I2 (1.1) Both I1 and I2 are random variables and E{Ii}= Pr { Ii =1}= Ri, where E{.}denotes the expected value and Ri is the reliability of Ci, i = 1, 2. Notice that s (I1, I2) assumes only the value 0 (if the system fails) or 1 (if the system survives). The reliability of the system is Rsys = Pr{s(I1, I2) = 1}  (1.2) = Pr{ I1 = 1; I2 = 1} But due to the independence of I1 and I2, Pr{ I1 = 1, I2 = 1}= Pr{ I1 = 1}Pr { I2 = 1} Hence Rsys = R1. R2 (1.3) Thus, if we define the function s(x1,x2)=x1.x2, for all x1,x2 in [0,1] Then www.ijera.com Rsys = Pr{s (I1, I2)=1} =s(R1,R2) (1.4) We can extend this result to a system of n independent components connected in series. Thus, let n s(x1,…..xn) =  xi i 1 (1.5) for all xi in [0,1], where n  ai = a1, a2, … an i 1 Then Rsys = Pr {s(I1,I2,I3…In)=1} = R1R2 …. Rn (1.6) = s (R1,, … Rn) Notice that if T1,…. Tn are the actual failure times of the n components, then the failure time of a system connected in series is Ts = min Ti 1  i n A system of two components, C1 and C2 is connected in active-parallel if the system fails only when both components fail. The parallel structure function is p (x1,x2) = 1 – (1 – x1) (1 – x2)  (1.7) 0  x1, x2  1. In terms of the indicator functions I1 and I2, p (I1,I2)= 1 – (1 – I1) (1 – I2) = I1 + I2 – I1 I2  (1.8) 2107 | P a g e
  • 2. Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110 Thus p (I1, I2) = 0 iff both I1 = 0 and I2 = 0. In this case, if I1 and I2 are independent, Rsys = Pr {p (I1, I2) = 1}= 1 – E {1 – I1} E {1 – I2} = 1 – (1 – R1) (1 – R2) = p (R1, R2) If the system is comprised of n independent components, connected in active parallel, then n Rsys = p (R1,….Rn) = 1 -  (1 – Ri) i 1 When Cortisol (100µg CRH alone) is given to youngmen , Rsys = 1- [(1- R1) (1 – R2) (1 – R3) (1 – R4) (1 – R5) (1 – R6)] Rsys = 0.9999 Similarly, for other cases also Rsys = 0.9999 II. APPLICATION Aging appears to be accompanied by a progressive disturbance of the hypothalamus pituitary – adrenal (HPA) system which is the most important mediator of the neuro-endocrine response to stress [12] However there is growing evidence from animal studies that age-dependent dysfunctioning of the HPA system is not restricted to the hippocampus and hypothalamus but occurs also at the pituitary Plasma cortisol (left) ACTH (right) concentrations prior to and after stimulation with 100μg of human corticotropin releasing hormone (hCRH) alone (upper panels) and a combination of www.ijera.com www.ijera.com level. Also, two human studies have reported [7,8] on a tendency towards enhanced peak ACTH and cortisol concentrations following administrative of ovine CRH in healthy elderly compared to younger controls. Contrasting with the rather inconsistent findings after stimulation solely with CRH, substantially elevated responses of ACTH and cortisol were found in the healthy elderly when stimulated with a combined bolus injection of hCRH and vasopressin (VP) [2]. Vasopressin is besides CRH, the most important secretgogue for ACTH [1,3,13]. Hence, the combined administration of both peptides appears to be more physiological test of pituitary-adrenal functioning. The effect of gender on pituitary adrenal activity is even less well investigated than that of age, although a distinct dependency on the sex is well known for the release of some other pituitary hormones [4]. Thus, in humans cortisol secretion during the 24-h cycle did not differ significantly between the sexes, but ACTH secretion was higher in men than in women [4]. The present study aimed to distinguish the effects of age and gender on pituitaryadrenal responsiveness to hCRH alone and to a combined injection of hCRH and Vasopressin hCRH (100 μg) and arginine vasopressin (VP 0.5 IU); lower panels: (a) in young (thick solid) and old men (thin solid) (b) in young (thick dashed) and old women (thin dashed) 2108 | P a g e
  • 3. Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110 III. MATHEMATICAL RESULTS By using the formula R(t) www.ijera.com young women =    t  t0     , t  t0        1.2 exp    1 R(t) 0.8 We get the following figures CRH Cortisol 0.6 ACTH 0.4 Young Men CRH/ VP Cortisol 0.2 1.2 ACTH 0 1 1 2 3 5 6 Time 0.8 R(t) 4 CRH Cortisol 0.6 ACTH 0.4 CRH/VP Cortisol 0.2 Old women ACTH 0 1.2 1 2 3 4 5 6 1 Time R(t) 0.8 CRH Cortisol 0.6 0.4 Old men ACTH 0.2 CRH / VP Cortisol ACTH 0 1.2 1 2 3 4 5 6 1 Time R(t) 0.8 CRH Cortisol 0.6 ACTH 0.4 CRH/VP Cortisol ACTH 0.2 0 1 2 3 4 Time www.ijera.com 5 6 IV. MEAN TIME TO FAILURE FUNCTION MTTF = t0 + θ  1  1       2109 | P a g e
  • 4. Dr. S. Lakshmi et al Int. Journal of Engineering Research and Applications ISSN : 2248-9622, Vol. 3, Issue 6, Nov-Dec 2013, pp.2107-2110 MTTF values for young men Group Cortisol [2] ACTH CRH 3.9723 4.8694 CRH + VP 3.9740 4.1321 MTTF values for old men Group Cortisol [3] ACTH CRH 4.001 4.2098 CRH + VP 4.0209 4.054 MTTF Values for young women Group Cortisol [4] ACTH CRH 3.9883 4.58 CRH + VP 3.9923 4.1335 MTTF values for old women Group Cortisol ACTH CRH 4.0187 4.0138 3.9572 [6] 3.9577 CRH + VP [5] V. CONCLUSION The reliability to test the effect of cortisol and ACTH are measured and compared with the mathematical model. Basal secretion of cortisol did not differ among groups. But basal concentrations of ACTH were diminished in young women. Pituitary responses to hCRH did not differ between young men and women. However , responses to hCRH/VP were stronger in the younger females. Pituitary – adrenal secretory responses were greater in old than in young men after sole injuction of hCRH and even more so after combined injection of hCRH/VP. In old women, pituitary adrenal secretory responses were also greater than in young women. But, in particular for responses to hCRH/VP, the effects were less distinct than within the men. From the mathematical model, the values for cortisol and ACTH for young men, old men,. young women, old women are compared (i) when CRH alone is administered . (ii) when CRH and AVP combined is administered. MTTF values are obtained for all the four cases. Even though the time is small, the fractions show a high degree of intra individual constancy overtime,which proves the medical report. The results in medical model suggest that atleast in men, an impaired feed back inhibition of pituitary adrenal secretory activity contributed to the age induced increment in pituitary adrenal responsiveness.[9,10,11] REFERENCES [1] Axelrod J . Reisine TD. Stress hormone: their interaction and regulation . Science 1984: 224:452- 459 www.ijera.com [7] [8] [9] [10] [11] [12] [13] www.ijera.com Dodt C.Dittmann J . Hruby J. Spath-Schwalbe E. Born J. Schutler R. et al. Different regulation of adrenocorticotropin and cortisol secretion in young. Mentally healthy elderly and patients with senile dementia of Alzheimer’s type. J Clin Endocrinol Metab 1991:72:272-276. Familari M. Smith AI. Funder JW, Arginine vasopressin is a much more potent stimulus to ACTH release from ovine anterior pituitary cells than ovine corticortropin releasing factor. Neuro endocrinology 1989:50:152-157 HO KY. Evans WS. Blizzard RM. Effects of sex and age on the 24 hour profile of hormone secretion in man: importance of endogenous estradiol concentrations. J Clin Endocrionol Mctab 1987: 64:51-58 Lakshmi. S and Shanmaga priya.S, Mathematical model for the Corticosteroid feed back effects on ACTH secretion in hypoadrenocorticism . Acta Ciencia Indica, 2008 Vol . XXX IV M, No.4 1767 Lakshmi.S and Senthil Kumar. P Stochastic model for cortisol secretion due to human stress in journal of Indian Acad Math,(2007) Vol 29, No. 2 PP. 313-321 Ohashi M. Fujio N. Kato K. Nawata H. Iharyashi H. Aging is without effect on the pituitary – adrenal axis in men . Gerontology 1986:32:335-339 . Pavlov EP. Harman SM. Chrousos GP. Loriaux DI,. Blackman MR . Responses of plasma adrenocorticotropin. Cortisol. and dehydroepiandrosterone to ovine corticotropinreleasing hormone in healthy aging men. J Clin Endocrinol Metab 1986:62:767-772. Reul JMHM. Rothuizen J. DeKloet ER. Agerelated changes in the dog hypothalamicpituitary – adrenocortical system: Neuroendocrine activity and corticosteroid receptors. J Steroid Biochem Mol Bio1991:40:63-69. Sapolsky RM. Krey LC. McEwen BS.The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocr Rev 1986:77: 284-304 Sapolsky RM, Krey LC. McEwen BS. Glucorticoid sensitive hippocampal neurons are involved in terminating the adrenocortical stress response.Proc Natl Acad Sci USA 1984:81: 6174-6177 . Selye H. Tuchweber B. Stress in relation to aging and disease. In Everitt A. Burgaes J. editors. Hypothalamus. pituitary and aging . Springfield.II: Charles C Thomas 1976:557-573 . Spath - Schwalbe E. Fehm HL. Born J. Pfeiffer EF. Combined corticotropin releasing hormone vasopressin test: a new test for the evaluation of the pituitary adrenal system. Horm Metab Res 1987: 19: 665-666. 2110 | P a g e