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

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

Hormonal Mechanisms of Sleep Restriction - Axis Study (clinicaltrials.gov) - P1 | N=80 | Active, not recruiting | Sponsor: Peter y. Liu | Trial completion date: Mar 2025 ➔ Jun 2026

Trial completion date

Hormonal Mechanisms of Sleep Restriction - Axis Study in Older Men and Postmenopausal Women (clinicaltrials.gov) - P1 | N=5 | Active, not recruiting | Sponsor: Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center | Trial completion date: Jul 2024 ➔ Jun 2026

Trial completion date

Adrenocorticotropic hormone combined with vigabatrin as a second-line therapy for West syndrome. (PubMed, Arq Neuropsiquiatr) - "The patients were treated with intramuscular tetracosactide depot added to vigabatrin and were prospectively followed up for ≥ 1 year. After a median follow-up of 21 months, 73.6% of the patients developed epilepsy.Combined therapy demonstrated a favorable efficacy profile in achieving clinical and electroencephalographic remission but was associated with significant seizure relapse rates in the medium term. Thus, it represents a feasible option for patients in whom initial treatment has failed."

Journal • CNS Disorders • Epilepsy

Checkpoint Inhibitor Therapy and Adrenal Insufficiency: The Critical Role of ACTH Measurement (ENDO 2025) - "She had a history of cervical adenocarcinoma treated with carboplatin/paclitaxel/bevacizumab plus pembrolizumab for 11 months...Peak cortisol after cosyntropin 7.3 ug/dL. She was started on hydrocortisone and later fludrocortisone due to potassium on the higher end of normal... The adverse events associated with ICI is unpredictable. The diagnosis of AI is challenging in these patients because nonspecific symptoms can be attributed to side effects from chemo or immunotherapy. Our patient presented with common features of primary AI."

Checkpoint inhibition • Cervical Adenocarcinoma • Cervical Cancer • Endocrine Disorders • Fatigue • Nephrology • Oncology • Renal Disease • Solid Tumor

No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: prophylactic use of cosyntropin following accidental dural puncture. Comment on Br J Anaesth 2025; 135: 148-54. (PubMed, Br J Anaesth) - No abstract available

Journal • Obstetrics • Pain

Effects of Hypokalemia on Adrenal Vein Sampling in the Evaluation of Primary Hyperaldosteronism (ENDO 2025) - "We hypothesized that the effect of hypokalemia on lateralization would be minimal during AVS sampling done during continuous cosyntropin infusion.MethodsWe retrospectively analyzed 102 consecutive patients who underwent AVS for hyperaldosteronism between 2017 and 2024...Patients with hypokalemia immediately prior to AVS are more likely to have an aldosterone-producing adenoma. If lateralization occurs, patients are likely to have a similar reduction in blood pressure medications whether they have hypokalemia or not."

Endocrine Disorders

Not Just An Aldosterone Producing Adenoma (ENDO 2025) - "Testing for co-secretion of cortisol was confirmed by inappropriately high levels of cortisol at 5.3μg/dl after the dexamethasone suppression test...In APA with cortisol co-secretion, AVS is unnecessary due to 20% risk of misclassifying unilateral disease as bilateral adrenal hyperplasia (BAH), since cosyntropin infusion can falsely suppress lateralization...Patients with an APA that co-secretes cortisol require stress dose steroids intraoperatively followed by a taper to prevent a life threatening adrenal crisis. Overall this case illustrates the importance of diagnosing APAs that co-secrete cortisol as this leads to essential management changes."

Cardiovascular • Cushing’s Disease • Endocrine Disorders • Hypertension

Double mutation for multiple endocrine neoplasia associated with congenital adrenal hyperplasia. (PubMed, Endocrinol Diabetes Metab Case Rep) - "A 39 year old female with signs of hyperandrogenism, was diagnosed with congenital adrenal hyperplasia after a cortrosyn test...Multiple endocrine neoplasia syndromes describe a group of heterogeneous diseases. Hyperparathyroidism is common among multiple endocrine neoplasia syndromes."

Journal • Congenital Adrenal Hyperplasia • Cushing’s Disease • Endocrine Cancer • Endocrine Disorders • Gastroenterology • Oncology • Peptic Ulcer • Solid Tumor • Thyroid Gland Carcinoma • Thyroid Gland Medullary Carcinoma • RET

No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: a double-blind randomised controlled clinical trial. (PubMed, Br J Anaesth) - P2 | "A single dose of tetracosactide did not demonstrate efficacy in preventing EBP needs in postpartum PDPH, and there was no effect on the intensity, duration of headaches, and physical activity limitations. Given these findings, adrenocorticotropic hormone analogues should not be considered for this indication."

Clinical • Journal • Anesthesia • Obstetrics • Pain

Late Diagnosis of Classic Simple Virilizing Congenital Adrenal Hyperplasia in a Young Female (ESPE-ESE 2025) - "She was also on long term hydrocortisone 10 mg nightly since childhood for hypocortisolism diagnosed during a hospital admission for fever and diarrhoea...Morning cortisol levels were low with elevated ACTH levels and lack of cosyntropin response, consistent with primary hypocortisolism...Our patient was started on oral dexamethasone at night, which was subsequently changed to oral prednisolone twice a day, resulting in significant improvement in hirsutism and acne, as well as return of menses. Special attention was given to her concurrent carbamazepine administration which would increase clearance of the administered glucocorticoids. Discussion and Conclusion The presentation of secondary amenorrhoea with virilisation in a young female is uncommon, with CAH being one of the possible causes. We will discuss the management of CAH (particularly with regard to steroid choice) and how it can be individualised to incorporate patient’s preferences, desired goals for fertility..."

Acne Vulgaris • Alopecia • CNS Disorders • Congenital Adrenal Hyperplasia • Endocrine Disorders • Epilepsy • Gynecology

Adrenal Venous Sampling: Practical Insights and Case Studies. (PubMed, Urol Clin North Am) - "In this article, the authors present 3 interesting cases that underscore the importance of data analysis. Additionally, they emphasize that primary aldosteronism represents a spectrum of aldosterone production, highlighting the fundamental need for long-term follow-up due to the significant variability in patient responses to treatment."

Journal • Review • Endocrine Disorders

PHARMACOLOGICAL INTERVENTIONS FOR PREVENTING POST-DURAL PUNCTURE HEADACHE. SYSTEMATIC REVIEW (IARS-SOCCA 2025) - "Pooling trials comparing intravenous dexamethasone vs. placebo, there was no evidence of a difference in CPPD outcomes (RR 0.71, 95% CI 0.47 to 1.08) (11 RCTs, 2244 participants) (Very low certainty of the evidence) (4–14)...Polling trials comparing intravenous ondansetron vs. placebo, there was no evidence of differences (RR 0.56, 95% CI 0.29 to 1.09) (4 RCTs, 620 participants) (Very low certainty of the evidence) (25,27–29) (Table 1)...Comparisons with two available RCTs: When comparing oral pregabalin vs. placebo, there was a reduction in the number of participants affected by PDPH (20,21).Comparisons with a single individual available RCT: These interventions reduced incidence of PDPH in a single RCT: Intravenous propofol (22); Epidural Morphine (23); Intravenous Caffeine (24); Oral Magnesium (25); Intravenous Magnesium (26); Intravenous Cosyntropin (27); Intravenous Neostigmine and Atropine (28); Spinal Dexamethasone vs. Spinal Normal Saline (29).Half of the..."

Review • CNS Disorders • Pain • Psychiatry

Adrenal Insufficiency Due to Adrenal Insult Following Acute Pancreatitis in a Child. (PubMed, JCEM Case Rep) - "Cortisol did not rise following administration of 250 µg of cosyntropin. Magnetic resonance imaging of the abdomen obtained 8 months later showed diminutive adrenal glands with a marked decrease in size compared to the initial CT scan finding. She has continued to require replacement doses of hydrocortisone and fludrocortisone."

Journal • Cardiovascular • Endocrine Disorders • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Nephrology • Pancreatitis • Rare Diseases • Renal Disease

Age effects on measurements of hypothalamic-pituitary-adrenal axis activation in laying hens. (PubMed, Poult Sci) - "Ten each of Lohmann LSL-Lite hens received either a saline-mannitol or synthetic ACTH (ACTH1-24) injection at 6, 17, and 26 weeks of age (WOA)...The results of this study suggest that the H:L ratio is not an accurate measure of acute HPA activation during the pullet phase and that plasma cortisol and albumen corticosterone and cortisol are not an accurate measure of acute HPA activation during the pullet or adult phases. Corticosterone may have some utility in capturing a physiological stress response in pullets and adult hens but requires further investigation."

Journal