Hypothalamic-pituitary-adrenal axis hypofunction after adrenocorticotropic hormone therapy

Abstract

Purpose: To investigate the adverse effects of adrenocorticotropic hormone (ACTH) therapy on function of the hypothalamic-pituitary-adrenal (HPA) axis and the necessity of subsequent adrenocortical hormone replacement therapy (HRT). Methods: We conducted a retrospective review of patients with epilepsy who received ACTH therapy and underwent assessment of HPA axis function. Results: Six cases analyzed for hormones, including a symptomatic patient with HPA axis insufficiency (HPAI), were studied. Serum cortisol concentrations in the morning were at HPAI levels (<5.0 μg/dL) in three cases, at suspected HPAI levels (>5.0 and <13 μg/dL) in two cases, and normal in one case. However, in the corticotrophin-releasing hormone (CRH) test, while both serum cortisol and plasma ACTH levels were reactive in five cases, only one case exhibited lazy patterns in the time courses of serum cortisol and plasma ACTH levels. Consequently, all six patients who received ACTH therapy had some degree of HPA axis hypofunction for approximately 2-3 months after ACTH therapy and were treated with HRT. Conclusion: Patients who receive ACTH therapy may be at risk of HPA axis hypofunction for a certain period and HRT may be recommended until their serum cortisol levels return to basal levels.