Anaphylactic Shock after Synthetic Adrenocorticotropin-(1–18) in a Patient with Isolated Adrenocorticotropin and β-Lipotropin Deficiency

Abstract

A 58-yr-old woman had frequent hypoglycemic attacks, undetectable levels of plasma cortisol, ACTH, and beta-lipotropin, and deficient responses of these hormones after insulin induced-hypoglycemia and metyrapone. Her GH responses to arginine infusion were normal as were her gonadotropin responses to LRH. Her TSH and PRL responses to TRH were abnormally high. Anaphylactic shock occurred after the injection of either synthetic ACTH-Z-(1-24) (Cortrosin-Z) or ACTH-(1-18) (Acthormone). She had received two prior injections of synthetic ACTH-Z-(1-24) 2 months earlier. Circulating anti-ACTH antibody was found in her plasma by radioimmunological methods, but this antibody did not prevent corticosterone production by ACTH in an in vitro ACTH bioassay system. The pathogenic significance of this antibody in the ACTH deficiency is doubtful, and the etiology of the isolated ACTH and beta-LPH deficiency is not clear.

Hypothalamic‐pituitary‐adrenal axis suppression in asthmatic children on inhaled corticosteroids: Part 1. Which test should be used?

“…They are considered to be safe, easy to perform and sensitive. However, anaphylaxis to ACTH has been described (61, 62). Moreover, several versions exist – one utilizing a standard dose of 1 μ g, others utilizing a variable dose corrected for body surface area (1 μ g or 0.5 μ g/1.73 m 2 or 0.5 μ g/m 2 ).…”

Recovery of Ovulatory Menstrual Cycles under Hydrocortisone in Two Amenorrheic Women with Isolated Corticotropin Deficiency

“…Its etiology remains unclear in most cases, but there are some findings which argue in favor of autoimmune hypophysitis in some cases [1,2], Although it is a distinct anatomical entity, clinical symptoms of ICD are similar to those of com plete anterior hypopituitarism such as Sheehan's syn drome. The amenorrhea, in particular, is almost always present in women with ICD but its mechanism is not obvious since the gonadotrophs are not damaged in this disease.…”