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

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

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

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 • Lung Cancer • Nephrology • Non Small Cell Lung Cancer • Oncology • Renal Disease • Solid Tumor

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

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 2024 ➔ Dec 2025 | Trial primary completion date: Dec 2024 ➔ Dec 2025

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

What is the impact of etiology, lead time to treatment, and parental awareness on outcomes in infantile epileptic spasm syndrome? (PubMed, Epilepsy Behav) - "Our research revealed that the etiology was the most significant factor influencing the long-term outcomes of IESS. Additionally, we demonstrated that the clinicians who initially encountered the patients promptly referred them to pediatric neurology departments, despite the fact that the families' seizure awareness was poor. To help prevent this circumstance, it is important to provide information about infantile spasms to the families of high-risk infants."

Journal • CNS Disorders • Epilepsy • Hematological Disorders • Pediatrics

Defining the Mechanisms Underlying Adrenal Insufficiency in Cirrhosis (clinicaltrials.gov) - P=N/A | N=76 | Completed | Sponsor: University of Virginia | Active, not recruiting ➔ Completed

Trial completion • Endocrine Disorders • Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease • IL10 • IL6 • TNFA

Case Report: Cosyntropin Use For A Dural Puncture In An Obstetric Patient with Multiple Sclerosis. (ASA 2024) - "Following her cerclage placement, 750 micrograms of cosyntropin was administered over 8 hours to decrease the chances of a PDPH. No adverse events have been noted four months post-operatively."

Case report • Clinical • CNS Disorders • Multiple Sclerosis • Obstetrics

Prophylactic cosyntropin after unintentional dural puncture and incidence of post-dural puncture headache and epidural blood patch use: A retrospective cohort study (2019-2022). (PubMed, Int J Obstet Anesth) - "Prophylactic cosyntropin following UDP was not associated with a significant decrease in PDPH rate or use of epidural blood patch for management of PDPH. There was no significant difference in the rate of adverse hyperglycemic or hypertensive events amongst those who did or did not receive cosyntropin."

Journal • Retrospective data • Anesthesia • Diabetes • Pain

Therapeutic options for recalcitrant post-dural puncture headache after cervical epidural injection. (PubMed, Interv Pain Med) - No abstract available

Journal • Pain

Utility of Adrenal Vein Sampling With and Without Ultra-Low Dose ACTH Infusion in the Diagnostic Evaluation of Primary Aldosteronism. (PubMed, Endocrinol Diabetes Metab) - "Prospective studies directly comparing low and conventional dose ACTH AVS protocols and long-term patient outcomes are needed to help define the optimal ACTH dose for accurate PA subtyping."

Journal • Retrospective data • Endocrine Disorders

Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial. (PubMed, Mil Med Res) - P3 | "Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care. To introduce the technology readiness level in real-life critically ill patients, further large-scale studies are required."

Clinical • Journal • P3 data • Surgery • Cardiovascular • Critical care • FLT3 • IL10 • IL6

Examining aldosterone plasma concentration alterations post-ACTH stimulation in healthy subjects: a systematic literature review and meta-analysis on ACTH's role in aldosterone secretion. (PubMed, Hormones (Athens)) - "The presented evidence strongly supports the contribution of ACTH to aldosterone secretion regulation beyond the renin-angiotensin-aldosterone axis. Establishing a normal aldosterone response threshold following standardized ACTH stimulation could aid in identifying individuals with ACTH-dependent aldosterone hypersecretion and guide personalized and effective treatment strategies."

Journal • Retrospective data • Review

Cause or Coincidence? A Case of Primary Adrenal Insufficiency Diagnosed in a Female with Hemochromatosis (AACE 2024) - "PAI was suspected and later confirmed with an insufficient cortisol response to cosyntropin and elevated ACTH, though plasma renin activity was normal...She was treated with hydrocortisone with normalization of sodium and symptomatic improvement...Furthermore, the initial adrenal enlargement and subsequent atrophy noted on CT imaging suggests a possible diagnosis of adrenal hemorrhage from anticoagulation use which should have raised suspicion for PAI, along with other risk factors such as infection, hypotension, and hemochromatosis. Regardless of the cause, it is imperative to keep a high index of suspicion for PAI, particularly for patients displaying signs and symptoms in the setting of multiple risk factors."

Clinical • Anemia • Cardiovascular • Dermatology • Diabetes • Endocrine Disorders • Fatigue • Genetic Disorders • Heart Failure • Hematological Disorders • Hepatology • Hypertension • Hypoglycemia • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Musculoskeletal Diseases • Nephrology • Oncology • Orthopedics • Pain • Renal Disease • Type 2 Diabetes Mellitus

Cirrhosis and Adrenal Insufficiency: A Medical Dilemma (AACE 2024) - "Given the low blood pressure, spironolactone, furosemide, and carvedilol were all held...Random cortisol (3.3 ug/dL), AM ACTH (16.6 pg/ml), and AM cortisol levels were low (5.5 ug/dL), and repeat cortisol levels 30 and 60 minutes post cosyntropin challenge were all within the low normal range (10.8 ug/dL and 12.4 ug/dL respectively). The patient was started on hydrocortisone 10 mg in the morning and 5 mg in the afternoon...In this case, we highlight the importance of early consideration of AI among cirrhotic patients, even when diagnosing it can be challenging. Prompt recognition of AI and administration of steroids is exceptionally vital; otherwise, complications may lead to detrimental consequences and death."

Addiction (Opioid and Alcohol) • Cardiovascular • Endocrine Disorders • Fibrosis • Gastroenterology • Heart Failure • Hepatology • Hypertension • Hypotension • Immunology • Liver Cirrhosis • Liver Failure • Nephrology • Pain • Renal Disease

From Cushing'S To Addison'S: A Diagnostic Dilemma In The Evaluation Of Elevated Acth (ENDO 2024) - "Her 30- and 60-min cortisol levels were both 1.80 post cosyntropin injection...Her clinical status improved with hydrocortisone, fludrocortisone, and levothyroxine.During her initial evaluation in 2018, she had reported rapid weight gain, headaches, facial fullness, joint pain, and easy bruising, all of which improved shortly after surgery...Of note, 24-hour urine cortisol and dexamethasone suppression tests were unremarkable despite use of oral contraceptive pills (OCPs)... This case underscores the importance of scrutinizing and reevaluating initial diagnoses. The patient's journey cautions against anchoring bias and highlights the importance of correlating symptoms with laboratory testing. Upon deeper review of her records, doubts arose about the prior diagnosis of CD as elevated cortisol and weight gain may be due to OCPs."

Late-breaking abstract • Cushing’s Disease • Endocrine Disorders • Fatigue • Musculoskeletal Diseases • Musculoskeletal Pain • Nephrology • Orthopedics • Pain • Pituitary Gland Carcinoma • Rare Diseases • Renal Disease

Endogenous ACTH but not Intermittent Cosyntropin Prevents Dexamethasone-Induced Adrenal Suppression in Mice (ENDO 2024) - "The adrenal is the major anatomic locus of post-withdrawal IAI in mice, which may involve early defects in both cortical size and secretory function. Novel therapies that mimic endogenous ACTH signaling during the period of GC exposure may prevent IAI.Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins."

Preclinical • Endocrine Disorders • Nephrology • Renal Disease

Hormonal Mechanisms of Sleep Restriction - Axis Study (clinicaltrials.gov) - P1 | N=80 | Active, not recruiting | Sponsor: Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center | Trial completion date: Dec 2024 ➔ Mar 2025

Trial completion date

No effect of tetracosactide for treatment of Postdural Puncture Headaches in postpartum – randomized controlled study (Euroanaesthesia 2024) - "Apart from the lack of clinically relevant effects, the utilization of tetracosactide in this context resulted in a one-day increase in hospitalization. Consequently, ACTH analogues should be excluded from PDPH management protocols."

Clinical • Anesthesia • Obstetrics • Pain