Synacthen Depot (cosyntropin) / Novartis, Mallinckrodt, Alliance, Pharmanovia - LARVOL DELTA

Acute Intraoperative Adrenal Crisis During an Orthotopic Liver Transplant (ASA 2026) - "Adrenal insufficiency was suspected and empiric hydrocortisone was administered intraoperatively. ICU evaluation confirmed chronic secondary versus acute mixed adrenal insufficiency via low ACTH and blunted cosyntropin response, ultimately attributed to cirrhosis-associated HPA axis suppression. Stress-dose corticosteroids and intraoperative continuous renal replacement therapy (CRRT) facilitated successful transplantation two days after the initial aborted procedure. This case highlights the importance of maintaining a broad differential diagnosis when managing intraoperative refractory hypotension."

Endocrine Disorders • Fibrosis • Hepatology • Hypotension • Immunology • Nephrology • Renal Disease • Transplantation

Efficacy of synthetic ACTH in confirmed and presumed monogenic developmental and epileptic encephalopathies. (PubMed, Epileptic Disord) - "These findings suggest that ACTH may be associated with sustained electroclinical improvement in selected genetically defined DEEs. The identified network-level interactions between ion channel-related genes and intracellular signaling pathways provide a potential molecular framework for understanding variability in treatment response."

Journal • CNS Disorders • Epilepsy • ATF2 • CACNA1E • CACNG3 • ZNF501

Bilateral Adrenal Primary Aldosteronism Is Uniformly Present in Hypertensive Afro-Caribbean First-Generation Immigrants to Western Canada. (PubMed, J Am Heart Assoc) - "Among first-generation African immigrants with hypertension, 93% fit a clear diagnosis of PA, a prevalence figure far in excess of any other population ever reported. Most of the PA phenotype was bilateral aldosterone excess; surgical cases and complete responders to adrenalectomy were rare. This, the largest detailed study of PA in African patients with hypertension, if confirmed, has important implications for hypertension assessment and treatment for African Black patients."

Journal • Cardiovascular • Endocrine Disorders • Hypertension • Nephrology

In ovo dexamethasone elicits an increase in ACTH-stimulated glucocorticoid release but no effects on fear behaviors in Pekin ducks. (PubMed, Poult Sci) - "At 3 weeks of age, ducks were then given an adrenocorticotropic hormone (ACTH; 0.0625 mg/kg cosyntropin in 1.0 ml saline) challenge (n = 6/treatment) or control (1.0 ml saline per bird)...The novel environment test showed only an age effect between weeks 1 and 5. Our results show that the in ovo glucocorticoids impact physiological, but not necessarily behavioral responses."

Journal

Steroidal response following intravenous administration of long-term frozen tetracosactide acetate in healthy Beagles. (PubMed, J Vet Intern Med) - "Long-term freezing of TCA in plastic syringes offers a cost-effective strategy and practical alternative during supply shortages."

Journal

Massive Prostatic Solitary Fibrous Tumor Causing IGF-2 Mediated Non-Islet Cell Tumor Hypoglycemia: A Case of Doege-Potter Syndrome. (ENDO 2026) - "His morning serum cortisol was 8.4 μg/dL and ACTH 13.1 pg/mL, with an appropriate rise of cortisol to 20.5 μg/dL at 60 minutes after 250-μg cosyntropin...Hypoglycemia resolved with glucocorticoid therapy (dexamethasone 3 mg daily); however, poor functional status precluded surgical or systemic treatment...While surgical resection is curative, in those who are not candidates, glucocorticoid therapy can improve hypoglycemia, as in our case. This case underscores the importance of considering paraneoplastic hypoglycemia in patients with unexplained fasting hypoglycemia and large mesenchymal tumors, even when arising in rare locations such as the prostate."

Clinical • Diabetes • Hypoglycemia • Metabolic Disorders • Oncology • Pancreatic Cancer • Solid Tumor • Type 2 Diabetes Mellitus • CD34 • IGF1 • IGF2 • IR • VIM

Pituitary Involvement in Primary Central Nervous System Lymphoma: A Rare Presentation in A Young Patient (ENDO 2026) - "Workup revealed a sodium of 118 mM, morning cortisol of 1.0 mcg/dL, ACTH 9 pg/mL (6-50), cortisol 30 minutes after cosyntropin of 13.3 mcg/dL, TSH of 0.10 uIU/L and FT4 1.4 ng/dL which declined to 0.67 ng/dL over two weeks, prolactin 133 ng/mL, with undetectable LH, FS, and, estradiol, IGF-1 of 84 ng/mL (Z -1.6)...She was started on hydrocortisone and levothyroxine...She underwent chemotherapy with methotrexate and high dose steroids but had evidence of disease progression and was switched to cytarabine and etoposide...She was discharged on DDAVP and had been placed on cabergoline, yet her hypothalamic-pituitary-gonadal axis remained suppressed, suggesting central hypogonadism, and she later started estradiol and progestin...Full endocrinological recovery is seen in only 12% of cases, and persistent endocrine dysfunction has been seen in refractory or progressive lymphoma. The course and findings suggest the need for early and ongoing endocrinologic care in PCNSL to..."

Clinical • B Cell Non-Hodgkin Lymphoma • Bone Marrow Transplantation • CNS Lymphoma • Endocrine Disorders • Gynecology • Heart Failure • Hematological Malignancies • Lymphoma • Metabolic Disorders • Mucositis • Nephrology • Non-Hodgkin’s Lymphoma • Primary Central Nervous System Lymphoma • Renal Disease • IGF1

MON-481 - Pembrolizumab-Induced Hypophysitis Unmasked by Septic Shock and Persistent Hyponatremia (ENDO 2026) - "Urinalysis revealed a urinary tract infection, and empiric cefepime was initiated...Urine cultures grew Klebsiella pneumoniae sensitive to ceftriaxone, and antibiotics were de-escalated accordingly...Morning cortisol was low at 3.5 μg/dL with an inadequate cosyntropin response on the next day (baseline 0.9, 5.1 at 30 minutes, and 8.8 μg/dL at 60 minutes), and ACTH was suppressed ( < 5 pg/mL), confirming central adrenal insufficiency...Hydrocortisone replacement (10 mg twice daily) led to resolution of nausea, hemodynamic stability, and normalization of sodium...Central adrenal insufficiency contributed to refractory shock, persistent hyponatremia, and debilitating gastrointestinal symptoms. This case highlights the importance of maintaining a high index of suspicion for endocrine immune-related adverse events, even late in therapy, as early recognition and timely hormone replacement result in rapid clinical improvement."

Cardiovascular • Endocrine Disorders • Heart Failure • Hypotension • Infectious Disease • Lung Cancer • Nephrology • Pneumonia • Renal Disease • Septic Shock • Solid Tumor • Squamous Cell Carcinoma

Pembrolizumab-Induced Hypophysitis Unmasked by Septic Shock and Persistent Hyponatremia (ENDO 2026) - "Urinalysis revealed a urinary tract infection, and empiric cefepime was initiated...Urine cultures grew Klebsiella pneumoniae sensitive to ceftriaxone, and antibiotics were de-escalated accordingly...Morning cortisol was low at 3.5 μg/dL with an inadequate cosyntropin response on the next day (baseline 0.9, 5.1 at 30 minutes, and 8.8 μg/dL at 60 minutes), and ACTH was suppressed ( < 5 pg/mL), confirming central adrenal insufficiency...Hydrocortisone replacement (10 mg twice daily) led to resolution of nausea, hemodynamic stability, and normalization of sodium...Central adrenal insufficiency contributed to refractory shock, persistent hyponatremia, and debilitating gastrointestinal symptoms. This case highlights the importance of maintaining a high index of suspicion for endocrine immune-related adverse events, even late in therapy, as early recognition and timely hormone replacement result in rapid clinical improvement."

Cardiovascular • Endocrine Disorders • Heart Failure • Hypotension • Infectious Disease • Lung Cancer • Nephrology • Pneumonia • Renal Disease • Septic Shock • Solid Tumor • Squamous Cell Carcinoma

Characterization of Primary Aldosteronism based on Adrenal Venous Sampling and Computed Tomography results (ENDO 2026) - " Among 337 patients who underwent AVS, 315 (93.4%) had a successful procedure, with cosyntropin used in 95% of procedures (mean age 52.6 ± 12.2 years; 60.6% male; 96.2% with hypertension)... Our findings highlight the limitations of CT imaging alone for subtype classification as previously reported in the literature. Given that treatment strategies differ substantially between lateralizing and non-lateralizing disease, reliance on CT alone could lead to inappropriate management decisions. Expanded access to AVS, or development of reliable non-invasive alternatives such as new nuclear studies, is urgently needed."

Late-breaking abstract • Cardiovascular • Endocrine Disorders • Hypertension

Adrenal insufficiency influences the pattern of thyrotoxicosis toward triiodothyronine predominance. (PubMed, JCEM Case Rep) - "The FT3/FT4 ratio fell after the increased serum cortisol level via daily administration of tetracosactide acetate. The elevated FT3/FT4 ratio in this patient could be explained by increased T4 to T3 conversion in a low-cortisol state. It has been suggested that destructive thyroiditis, accompanied by a high FT3/FT4 ratio, is a valuable indicator of the accompaniment of adrenal deficiency."

Journal • Endocrine Disorders • Musculoskeletal Pain • Nephrology • Pain • Renal Disease

Utility of the post-cosyntropin urinary metabolomic profile for the subtype diagnosis of primary aldosteronism. (PubMed, J Hypertens) - "The probability of UPA is lower than 18% in patients with normokalemia, post-cosyntropin 24 h urinary cortisone greater than 384 μg/24 h and serum cortisol increase with cosyntropin greater than 14 μg/dl. Thus, AVS might be avoided in these patients, and targeted medical therapy can be initiated with no further procedures."

Clinical • Journal • Cardiovascular • Endocrine Disorders • Hypertension

Relative Adrenal Insufficiency is Associated With Worse Clinical Outcomes in Patients With Acute Decompensation of Cirrhosis and Hyponatremia. (PubMed, J Clin Exp Hepatol) - "ACTH stimulation was done using intravenous cosyntropin in 74 patients and subcutaneous long-acting porcine ACTH (AP) in 42 patients due to availability issues...Subcutaneous AP is a feasible alternative for diagnosing RAI in this population. AIIMS/IEC/23/49."

Clinical data • Journal • Addiction (Opioid and Alcohol) • Cardiovascular • Endocrine Disorders • Fibrosis • Heart Failure • Hepatology • Immunology • Nephrology • Renal Disease

Delayed-onset central adrenal insufficiency following adjuvant pembrolizumab therapy for renal cell carcinoma. (PubMed, BMJ Case Rep) - "Laboratory testing showed a markedly suppressed morning cortisol with an inappropriately low adrenocorticotropic hormone (ACTH) level and no response to cosyntropin, confirming central adrenal insufficiency. The patient improved rapidly after starting hydrocortisone replacement. This case highlights a prolonged interval between checkpoint inhibitor cessation and endocrine toxicity, emphasising the importance of continued surveillance for late-onset immune-related endocrinopathies even after therapy completion."

Journal • Endocrine Disorders • Fatigue • Genito-urinary Cancer • Hypotension • Nephrology • Oncology • Renal Cell Carcinoma • Renal Disease • Solid Tumor

No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: many unanswered questions. Response to Br J Anaesth 2025; 135: 1102-3. (PubMed, Br J Anaesth) - No abstract available

Journal • Obstetrics • Pain

Positron Emission Tomography (PET) Imaging of Cholesterol Trafficking: Clinical Evaluation of [18F]FNP-59 in Normal Human Subjects (Groups 2, 3 & 4) (clinicaltrials.gov) - P1 | N=24 | Recruiting | Sponsor: Benjamin Viglianti | Trial completion date: Dec 2025 ➔ Dec 2026 | Trial primary completion date: Dec 2025 ➔ Dec 2026

Trial completion date • Trial primary completion date • Cardiovascular • Hypertension

Stress and the Nervous System (clinicaltrials.gov) - P=N/A | N=23 | Completed | Sponsor: Brigham and Women's Hospital | Active, not recruiting ➔ Completed

Trial completion

Overnight Dexamethasone in Primary Aldosteronism Screening in Patients on Interfering Therapy (ODEPRASC): A Diagnostic Interpretability Study Protocol. (PubMed, J Clin Hypertens (Greenwich)) - P | "Previous research showed that combining objective thresholds and 2-day cosyntropin suppression was highly accurate in diagnosing PA among HT patients off interfering drugs. In light of poor PA screening rates, the ODEPRASC study may provide a rationale for an optimized diagnostic approach. Trial Registration: ClinicalTrials.gov identifier: NCT06740838."

Journal • Cardiovascular • Endocrine Disorders • Hypertension

Cardiac safety of low-dose ACTH therapy in infantile spasms: Evidence from electrocardiography and advanced echocardiography. (PubMed, Seizure) - "Even short-term, low-dose ACTH therapy is associated with subclinical conduction abnormalities and myocardial dysfunction in IESS patients. Routine cardiac monitoring, including advanced imaging modalities, should be integrated into ACTH protocols. Multidisciplinary management and larger multicenter studies are warranted to clarify the long-term cardiovascular implications of ACTH therapy in IESS."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Hypertension

AKI with Hyponatremia from Rivaroxaban-Induced Bilateral Adrenal Hemorrhage (KIDNEY WEEK 2025) - "Morning cortisol was low at 3.0 ug/dL and remained 3.0 ug/dL at 30 and 60 minutes post-cosyntropin administration. Endocrinology was consulted and started stress dose IV hydrocortisone (HC) with taper to oral (20mg/10mg every morning/evening) and fludrocortisone 0.05 mg daily...He was monitored in the outpatient setting and successfully converted to apixaban after a period of clinical stability...Although rare, adrenal hemorrhage has been described with the newer direct oral anticoagulants. Early detection can facilitate timely treatment and earlier engagement of appropriate consultants to improve outcomes."

Acute Kidney Injury • Anorexia • Cardiovascular • Endocrine Disorders • Fatigue • Heart Failure • Hematological Disorders • Hypotension • Immunology • Nephrology • Pulmonary Embolism • Renal Disease • Thrombosis

Arachnoiditis after COVID-Positive Epidural Blood Patch: A Case for Ketamine (ASRA-FALL 2025) - "A more cautious approach is to await resolution of the viremia while expanding conservative treatments to include theophylline, cosyntropin, and greater occipital nerve or sphenopalatine blocks2,3. 2021, pp. 244–252."

Clinical • Anesthesia • Back Pain • CNS Disorders • Human Immunodeficiency Virus • Infectious Disease • Musculoskeletal Pain • Novel Coronavirus Disease

Adrenal vein sampling with continuous infusion of cosyntropin for identifying surgically curable cases of primary aldosteronism. (PubMed, Clin Imaging) - "Continuous ACTH infusion was associated with high rates of AVS sampling selectivity as well as lateralization and was highly predictive of post-adrenalectomy clinical response. As such, it may be superior to traditional bolus-based stimulation."

Journal • Endocrine Disorders

A PULSE UNPREDICTABLE: COSYNTROPIN-INDUCED SVT AND ITS AFTERMATH (CHEST 2025) - "The AKI was attributed to her lisinopril, spironolactone and furosemide use, in combination with decreased oral intake. This is the first known case in the literature that highlights a very rare, yet plausible adverse effect of the frequently used co-syntropin challenge test causing non-refractory SVT necessitating cardioversion."

Acute Kidney Injury • Autism Spectrum Disorder • Cardiovascular • Chronic Kidney Disease • Endocrine Disorders • Genetic Disorders • Heart Failure • Hypertension • Hypotension • Nephrology • Renal Disease • Ventricular Tachycardia

Caffeine in the Management of Post-Dural Puncture Headache: A Narrative Review of Therapeutic Evidence (IHC 2025) - "Results One study compared caffeine to cosyntropin and found both provided similar levels of pain relief over time...However, due to methodological limitations and side effect profiles, further studies are needed to support its routine use as standard treatment. References https://doi.org/10.18502/cjn.v20i2.6745 https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.03.004 https://doi.org/10.30476/ijms.2023.99577.3166"

Review • CNS Disorders • Migraine

Outcomes After Unilateral Adrenalectomy in Asymmetrical Bilateral Primary Aldosteronism. (PubMed, Hypertension) - "A retrospective chart review was performed of cases from the Calgary AVS database with (1) successful AVS (selectivity index ≥3 bilaterally after cosyntropin stimulation); (2) lateralization by AVS (lateralization index ≥3), stimulated or unstimulated; (3) absence of contralateral suppression (contralateral suppression index ≥2 on the nondominant side) stimulated or unstimulated; and (4) underwent unilateral adrenalectomy guided by AVS lateralization...In patients with bilateral (elevated contralateral suppression index) but asymmetrical primary aldosteronism, unilateral adrenalectomy can achieve positive biochemical and clinical outcomes in the short to mid-term. Elevated contralateral suppression index should not necessarily preclude recommendation of unilateral adrenalectomy in patients with lateralized primary aldosteronism, though longer-term studies are needed to clarify the rates of disease recurrence and benefits of a debulking procedure."

Journal • Retrospective data • Endocrine Disorders