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Eur J Endocrinol. 2019 Dec;181(6):639-645. doi: 10.1530/EJE-19-0558.

Long acting porcine sequence ACTH in the diagnosis of adrenal insufficiency.

Author information

1
Departments of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India.
2
Departments of Biochemistry, Government Medical College, Thiruvananthapuram, India.
3
Community Medicine, Government Medical College, Thiruvananthapuram, India.

Abstract

Objectives:

Injectable tetracosactide hexa-acetate, ACTH 1-24 (Synacthen), is not marketed in many countries including India, whereas Injectable long acting porcine sequence, ACTH 1-39 (Acton Prolongatum®) is easily available and much cheaper. This study aimed to find the diagnostic accuracy of ACTH stimulation test using i.m. Acton Prolongatum® (acton prolongatum stimulation test, APST) in comparison with Synacthen (short synacthen test, SST) for the diagnosis of glucocorticoid insufficiency.

Methods:

Subjects with a suspicion of adrenal insufficiency based on clinical features underwent a SST with 250 µg Synacthen followed by APST using 30 units of Acton Prolongatum®. Serum cortisol levels were measured at 60 and 120 min following injection of Acton Prolongatum®. Stimulated peak cortisol of less than 18 µg/dL on SST was considered as adrenal insufficiency.

Results:

Forty seven patients with mean age of 36.7 ± 14.4 years were enrolled for the study. Based on SST, twenty (n = 20) persons were classified as having adrenal insufficiency, whereas twenty-seven (n = 27) were found to be normal. Area under the curve of APST (at 120 min) was 0.986 when compared to SST, thus proving its high accuracy. A serum cortisol cut off value of 19.5 µg/dL at 120-min following stimulation with Acton Prolongatum® showed a sensitivity of 100% and specificity of 88%.

Conclusion:

ACTH stimulation test using Acton Prolongatum® is an economical and accurate alternative to the short Synacthen test.

PMID:
31614334
DOI:
10.1530/EJE-19-0558
[Indexed for MEDLINE]

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