Corticotropin

Summary

Corticotropin (ACTH, adrenocorticotropic hormone) is a 39-amino acid pituitary peptide hormone used diagnostically to assess adrenal function and therapeutically in conditions such as infantile spasms, multiple sclerosis exacerbations, and certain inflammatory/autoimmune disorders. It stimulates the adrenal cortex to produce glucocorticoids.

Mechanism of Action

Binds to melanocortin-2 receptors (MC2R) on adrenal cortex cells, activating adenylyl cyclase via Gs protein, increasing cAMP, which stimulates synthesis and secretion of adrenocortical hormones including cortisol, corticosterone, and adrenal androgens.

Routes of Administration

Goals & Uses

• Nephrotic syndromeNephrologyModerate
• Infantile spasms (West syndrome)NeurologyHigh
• Adrenal insufficiency diagnosisEndocrinology / DiagnosticsHigh
• Acute gout flareRheumatologyModerate
• Rheumatic and collagen disordersRheumatology / ImmunologyModerate
• Multiple sclerosis acute exacerbationNeurology / ImmunologyModerate

Contraindications

• Live or live-attenuated vaccinesImmunologyHigh
• Adrenocortical insufficiency or hyperfunctionEndocrinologyHigh
• OsteoporosisMusculoskeletalModerate
• SclerodermaAutoimmuneHigh
• Systemic fungal infectionsInfectious DiseaseHigh

Adverse Effects

• HypokalemiaElectrolyteCommon
• HypertensionCardiovascularCommonHigh blood pressure
• Immunosuppression / increased infection riskImmunologyCommon
• HPA axis suppressionEndocrineCommon
• Skin hyperpigmentationDermatologicUncommon
• Cushing's syndrome / hypercortisolismEndocrineCommon

Drug Interactions

• NSAIDs (e.g., aspirin, ibuprofen)Moderate
• Vaccines (live)High
• Diuretics (thiazides, loop diuretics)Moderate
• Antidiabetic agents (insulin, oral hypoglycemics)Moderate
• Anticoagulants (warfarin)Moderate

Population Constraints

• Patients with active or latent tuberculosisInfectious DiseaseRelative
• PregnancyReproductive SafetyRelative
• Pediatric patients (neonates/infants)PediatricRelative
• Patients with diabetes mellitusMetabolicRelative
• Elderly patientsAgeRelative

Regulatory Status

• European UnionApprovedApproved: Diagnostic testing of adrenal function (cosyntropin/tetracosactide), Infantile spasms, Inflammatory and autoimmune conditionsTetracosactide (synthetic ACTH 1-24, Synacthen) is more commonly used in EU for diagnostics and some therapeutic indications.
• United StatesApprovedApproved: Infantile spasms, Multiple sclerosis acute exacerbation, Nephrotic syndrome, Rheumatic disorders, Collagen diseases, Dermatologic diseases, Allergic states, Ophthalmic diseases, Respiratory diseases, Edematous statesH.P. Acthar Gel (repository corticotropin injection) approved by FDA under NDA; Mallinckrodt is current manufacturer.
• United KingdomApprovedApproved: Diagnostic adrenal stimulation testing (Synacthen), Infantile spasms, Inflammatory conditionsSynacthen Depot (tetracosactide) approved by MHRA for therapeutic and diagnostic use; natural corticotropin preparations less commonly used.

H.P. Acthar Gel (repository corticotropin injection) is FDA-approved. Synthetic analogs such as cosyntropin (tetracosactide) are used diagnostically. Acthar Gel carries a broad label covering multiple indications including infantile spasms and various inflammatory/autoimmune conditions.

Evidence & Sources

No sources recorded yet.