Adrenocorticotropic Hormone

Adrenocorticotropic hormone (ACTH), or corti-cotropin, a peptide of 39 amino acids, is first synthesized as a larger precursor from which ACTH is derived by proteolytic cleavage. ACTH stimulates production of glucocorticoids from the adrenal cortex (see Chapter 60). Release of ACTH depends on diurnal rhythms with serum levels highest in the early morning. Secretion of this peptide also increases under stress. It is easier and less expensive to treat patients having adrenocortical insufficiency with glucocorticoid replacement therapy than it is to use ACTH. Therefore, use of ACTH (Acthar) is restricted to diagnosis; a shorter 24-amino acid analogue (Cosyntropin) is also used. Intravenous administration of ACTH should result in peak plasma levels of glucocorticoids within 30 to 60 minutes if the adrenal gland is functional. Prolonged administration of ACTH in a repository form, however, may be necessary to stimulate steroid production, because ACTH has long-term trophic effects on adrenal cells in addition to the rapid stimulation of steroid production. If the cause of steroid deficiency is at the level of the pituitary gland, ACTH should eventually stimulate steroid production.

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