Function of Tetracosactide in Adrenal Insufficiency

2018-08-18

Introduction 

Tetracosactide (also known as Tetracosactide) is a synthetic peptide that is identical to the 24-amino acid segment at the N-terminal of adrenocorticotropic hormone. Adrenocorticotropic Hormone(ACTH 1-24), a segment similar in all species, contains the biological activity that stimulates production of corticosteroids in the adrenal cortex. Tetracosactide exhibits the same activity as natural ACTH with regard to all its biological activities. Tetracosactide is usually used to treat adrenal insufficiency.

Pharmacologic action

Tetracosactide combines with a specific receptor in the adrenal cell plasma membrane and, in patients with normal adrenocortical function, stimulates the initial reaction involved in the synthesis of adrenal steroids (including cortisol, cortisone, weak androgenic substances, and a limited quantity of aldosterone) from cholesterol by increasing the quantity of the substrate within the mitochondria. Plasma ACTH levels were generally elevated in patients with primary adrenal insufficiency and did not respond to the ACTH stimulation test. Most patients with secondary adrenal insufficiency have normal plasma ACTH, and they have delayed or normal response to the ACTH stimulation test. Tetracosactide does not significantly increase plasma cortisol concentration in patients with primary or secondary adrenocortical insufficiency.

Function

Decreased levels of cortisol and UFC are characteristic of most patients with adrenal insufficiency. ACTH levels are the key to identifying primary or secondary adrenal insufficiency. Primary ACTH levels are elevated, and secondary ACTH levels are not high. Tetracosactide is less sensitive than ACTH and is acceptable to most patients with an allergic or allergic history of ACTH. It is suitable for the diagnosis of primary adrenal insufficiency.

Pharmacokinetics and metabolism

Long-term animal studies have not evaluated the carcinogenic or mutagenic potential of Tetracosactide. Intravenous injection can rapidly increase blood cortisol levels, and continuous intravenous infusion should be maintained when blood cortisol concentration is maintained. After intramuscular injection, blood cortisol peaked 1 hour after injection. High levels of cortisol can last for about 24 hours. However, Tetracosactide takes longer to absorb in the body and should be kept under frequent management during treatment.

References:

1. Liu Shiwei, Yang Jing, Wang Zemin, Wang Wei. Advances in evaluation methods of adrenal insufficiency. Chinese Remedies & Clinics,December 2010,Vol.10,No.12.

2. Cortrosyn (Organon). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company Inc; 1999. p. 2119-20.

3. Canada JR, editor. USP dictionary of USAN and international drug names 1998. Rockville, MD: The United States Pharmacopeial Convention Inc; 1997. p. 195.

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