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described the application of three carbohydrate tolerance tests to the diagnosis of disturbances in the endocrine control of metabolism. These were the glucose tolerance test, the insulin tolerance test, and the glucose-insulin tolerance test. When properly employed and interpreted, these tests are of considerable value. However, in practice, the insulin tolerance test has often proven disappointing in those situations in which it should be most valuable, i.e., conditions characterized by hypoglycemia unresponsive-ness. Characteristically in adrenal and pituitary insufficiency, and less so in hyperinsulinism, the response to insulin is somewhat exaggerated and the spontaneous rise in blood sugar after hypogly-cemia is much retarded. This is clear from the data of Fraser et al., when the individual curves for patients with hypopituitarism and Addison's disease are compared with the mean of the nor-mals, or conversely, when cases of myxedema or anorexia nervosa are compared to the mean of the panhypopituitary group. However, in practice , we have found considerable overlapping between the curves from cases of panhypopituitarism and Addison's disease and those from cases of myxedema and anorexia nervosa and with the normals, which makes individual curves-difficult to evaluate. While varying degrees of adrenal and pituitary insufficiency may occur in myxedema and anorexia nervosa, it is doubtful whether all the abnormal insulin tolerance tests in these conditions have this origin. Furthermore, the intravenous injection of insulin into patients with panhypopi-tuitarism or Addison's disease is attended by a very definite risk of severe or even fatal hypo-glycemia. For this reason, Fraser et al. recommended that one-half or one-third the usual dose of insulin be given to patients seriously suspected of suffering from these conditions. Often this results in equivocal responses and the necessity for repeating the test. Even in presumably normal individuals the symptoms of hypoglycemia may sometimes be sufficiently distressing as to make it desirable to terminate the procedure by giving glucose. The purpose of this communication is to describe a modification of the insulin tolerance test, the insulin-glucose tolerance test, which was designed to overcome some of the disadvantages of the former test. It is based on the observation by Somogyi (2) that in normal individuals the administration of glucose 30-60 minutes after insulin, i.e., during hypoglycemia, resulted in the development of greater hyperglycemia than the administration of the same amount of glucose without insulin. Thus, glucose magnified the normal homeostatic response to hypoglycemia. This response is presumably mediated by the …

THE INSULIN-GLUCOSE TOLERANCE TEST. A MODIFIED PROCEDURE FOR THE DETECTION OF HYPOGLYCEMIA UNRESPONSIVENESS IN PITUITARY AND ADRENAL INSUFFICIENCY