Residual Adrenal Function in Autoimmune Addison's Disease: Improvement After Tetracosactide (ACTH1–24) Treatment
Open accessAbstract
Context Despite lifelong steroid hormone replacement, there is excess morbidity and mortality associated with autoimmune Addison's disease. In health, adrenocortical cells undergo continuous self-renewal from a population of subcapsular progenitor cells, under the influence of ACTH, suggesting a therapeutic possibility. Objective We aimed to determine whether tetracosactide (synthetic ACTH1-24) could revive adrenal steroidogenic function in autoimmune Addison's disease. Design, setting, and patients Thirteen patients (aged 16-65 y) with established autoimmune Addison's disease for more than 1 year were recruited at the Newcastle University Clinical Research Facility. Intervention The intervention included a 20-week study of regular sc tetracosactide (ACTH1-24) therapy. Main outcome measures Serum and urine corticosteroids were measured during medication withdrawal at baseline and every 5 weeks during the study. Results Serum cortisol levels remained less than 100 nmol/L in 11 of 13 participants throughout the study. However, two women achieved peak serum cortisol concentrations greater than 400 nmol/L after 10 and 29 weeks of tetracosactide therapy, respectively, allowing withdrawal of corticosteroid replacement. Concurrently, urine glucocorticoid and mineralocorticoid metabolite excretion increased from subnormal to above the median of healthy controls. One of these responders remains well with improving peak serum cortisol (672 nmol/L) 28 months after stopping all treatment…
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Treatment of newly diagnosed autoimmune primary adrenal insufficiency patients with rituximab and established primary adrenal insufficiency patients with depot tetracosactide has demonstrated that regeneration of cortisol production is possible.
“Treatment of newly diagnosed autoimmune PAI patients with rituximab (176) and established PAI patients with depot tetracosactide (177) has demonstrated that regeneration of cortisol production is possible.”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [177]
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- Authors
- Gan, E. H., MacArthur, K., Mitchell, A. L., Hughes, B. A., Perros, P., Ball, S. G., James, R. A., Quinton, R., Chen, S., Furmaniak, J., Arlt, W., & Pearce, S. H. S.
- Affiliations
- Royal Victoria Infirmary (GB)
- University of Birmingham (GB)
- Corresponding author
- Pearce, Simon H. S.
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- 111-118
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2034192623
- Cited by
- 36
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 7 · 2020: 3 · 2019: 6 · 2018: 2 · 2016: 3 · 2015: 4 · 2014: 4
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research (ACF-2007-01-004)
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- autoimmune Addison's disease, tetracosactide, ACTH1-24, adrenal steroidogenesis, adrenal regeneration, serum cortisol, aldosterone, regenerative therapy
- MeSH terms
- Addison Disease, Adolescent, Adrenal Cortex Hormones, Adrenal Glands, Adult, Aged, Cosyntropin, Female, Humans, Infusion Pumps, Male, Middle Aged, Remission Induction, Treatment Outcome, Young Adult
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