Hormone adrenocorticotropic

With the introduction and use of monoclonal antibodies, the measurement of hormones is now accurate and precise. The production of hormones in cancer involves two separate routes. First, the endocrine tissue that normally produces it can produce excess amounts of a hormone. Second, a hormone may be produced at a distant site by a non-endocrine tissue that normally does not produce the hormone. The latter condition is called ectopic syndrome. For example, the production of adrenocorticotropic hormone (ACTH) is norraotopic by the pituitary and is ectopic by the small cell of the lung. Consequently, elevation of a given hormone is not diagnostic of a specific tumor, because a hormone may be produced by a variety of cancers. 

Lung (small cell), adrenal cortex, pancreatic, duodenal Lung (small cell) 

Pituitary adenoma, renal, lung Embryonal, choriocarcinoma, testicular (nonseminomas) Trophoblastic, gonads, lung, breast 

ACTH is a polypeptide hormone with 39 ammo acids and an MW of 4500 that is produced by the corticotropic cells of the anterior pituitary gland (see Chapter 50). In 1928 a patient was described having a small ceU carcinoma of the lung who had the signs and symptoms of what is now known to be cortisol excess. A small number of these carcinomas can produce pro-ACTH, the precursor to ACTH. This precursor has an MW of 22,000, a 5% bioactivity, and most of the immunoactivity of ACTH. Traditional RIA measures both the precursor and the hormone. One immunometric assay in use is specific for ACTH. 

Mobile phase Gradient. A was MeOH containing 10 mM sodium octanesulfonate. B was hufifer containing 10 mM sodium octanesulfonate. A B from 45 55 to 70 30 over 30 min, maintain at 70 30 for 1 h. (The buffer was 5.7 g monochloroacetic acid, 2.0 g NaOH, and 0.2 g disodium EDTA in 1 L water, pH 3.2.) 

Detector F ex 390 em 470 following post-column reaction. The column effluent mixed with 400 mM NaOH pumped at 0.15 mL/min and 0.05% ninhydrin pumped at 0.05 mL/min and the mixture flowed through a 12 m xO.33 mm ID reaction coil at 70° to the detector. 

Simultaneous angiotensin I, angiotensin II, angiotensin III, atrial natriuretic peptide, bombesin, bradykinin, gonadorelin (LHRH), somatoliberin, vasopressin 

Rhodes, G.R. Boppana, V.K. High-performance liquid chromatographic analysis of arginine-containing peptides in biological fluids by means of a selective post-column reaction with fluorescence detection, J.Chromatogr., 1988,444, 123-131. 

Mobile phase Gradient. A was 0.08% trifluoroacetic acid. B was MeCN 0.08% trifluoroacetic acid 70 30. A B from 70 30 to 50 50 over 30 min. 

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In the anterior pituitary gland (see Hormones, anteriorpituitaryhormones), both adrenocorticotropic hormones (ACTH) and the endogenous opiate hormone, P-endorphin, are synthesized from a common prohormone (2) (see Opioids,endogenous). In the adrenal medulla, five to seven copies of another opiate hormone, methionine—enkephalin (Met-enkephalin), and one copy of leucine—enkephalin (Leu-enkephalin) are synthesized from each precursor molecule (3). 

In humans, the hypothalamic-derived protein and the hormone noncovalent complexes are packaged in neurosecretory granules, then migrate along axons at a rate of 1 4 mm/h until they reach the posterior pituitary where they are stored prior to release into the bloodstream by exocytosis (67). Considerable evidence suggests that posterior pituitary hormones function as neurotransmitters (68) vasopressin acts on the anterior pituitary to release adrenocorticotropic hormone [9002-60-2] (ACTH) (69) as well as on traditional target tissues such as kidneys. Both hormones promote other important central nervous system (CNS) effects (9,70). 

Pregnenolone is transported from the mitochondria to the ER, where a hydroxyl oxidation and migration of the double bond yield progesterone. Pregnenolone synthesis in the adrenal cortex is activated by adrenocorticotropic hormone (ACTH), a peptide of 39 amino acid residues secreted by the anterior pituitary gland. 

Drugs with unknown mechanism of action are gabapentin, bromides (but see above effects on GABAergic transmission) and adrenocorticotropic hormone (ACTH), which is used in infantile spasms. 

Adrenocorticotrope Hormone (ACTH) Gluco-mineralocorticoid Receptors... 

Proopiomelanocortin (POMC) is the precursor peptide of hormones and neuropeptides expressed in the pituitary and the hypothalamus (adrenocorticotropic hormone (ACTH), lipotropin, a-melanocyte-stimulating hormone (aMSH), yMSH, 3-endorphin, and others). The main clinical consequences of POMC deficiency are adrenal insufficiency (due to absence of ACTH), red hair pigmentation (due to absence of MSH) and severe early-onset obesity (due to the lack of aMSH). 

Otfier fiormones accelerate tfie release of free fatty acids from adipose tissue and raise tfie plasma free fatty acid concentration by increasing the rate of lipolysis of the triacylglycerol stores (Figure 25—8). These include epinephrine, norepinephrine, glucagon, adrenocorticotropic hormone (ACTH), a- and P-melanocyte-stimulat-ing hormones (MSH), thyroid-stimulating hormone (TSH), growth hormone (GH), and vasopressin. Many of these activate the hormone-sensitive hpase. For an optimal effect, most of these lipolytic processes require the presence of glucocorticoids and thyroid hormones. These hormones act in a facilitatory or permissive capacity with respect to other lipolytic endocrine factors. 

FIGURE 10-3. Expected neurohumoral response to hypovolemia. ACTH, adrenocorticotropic hormone ADH, antidiuretic hormone CNS, central nervous system Na, sodium. (Reprinted from Jimenez EJ. Shock. In Civetta JM, Taylor RW, Kirby RR, eds. Critical Care. New York Lippincott-Raven 1997 369, with permission.)... 

Corticosteroids hasten functional recovery after relapses.27 Intravenous adrenocorticotropic hormone, intravenous methylprednisolone, or oral prednisone are used for treatment of relapses. Generally, intravenous methylprednisolone is considered the drug of choice for acute relapses.28... 

Pharmacotherapy generally is reserved for patients (1) in whom the ectopic adrenocorticotropic hormone-secreting tumor cannot be localized (2) who are not surgical candidates (3) who have failed surgery (4) who have had a relapse after surgery or (5) in whom adjunctive therapy is required to achieve complete remission. 

Adrenal hormone production is controlled by the hypothalamus and pituitary gland. Corticotropin-releasing hormone (CRH) is secreted by the hypothalamus and stimulates secretion of adrenocorticotropic hormone (ACTH), also known as corticotropin from the anterior pituitary. ACTH, in turn, stimulates the adrenal cortex to produce cortisol. When sufficient or excessive cortisol levels are reached, a negative feedback is exerted on the secretion of CRH and ACTH, thereby decreasing overall cortisol production. The control of adrenal androgen synthesis also follows a similar negative-feedback mechanism. 

ACTH, adrenocorticotropic hormone or corticotropin FDA, Food and Drug Administration HPA, hypothalamic-pituitary-adrenal IV, intravenously. aThe 250 meg dose has also been administered intramuscularly in an outpatient setting. The 1 meg dose is not FDA-approved. 

ACTH, adrenocorticotropic hormone or corticotropin CRH, corticotropinreleasing hormone. 

ACTH, adrenocorticotropic hormone or corticotropin CRH, corticotropin-releasing hormone CT, computed tomography MRI, magnetic resonance imaging 0, none +, mild ++, moderate +++, pronounced. 

Corticotropin [adrenocorticotropic hormone (ACTH)] has been used for acute gouty flares. Worldwide supply problems and the possible superiority of traditional corticosteroids have resulted in decreased use. 

Stress-induced adrenal insufficiency complicates 9% to 24% of septic patients and is associated with increased mortality. Adrenal-insuffident patients are identified by a adrenocorticotropic hormone (ACTH) stimulation test. Patients are given 250 meg ACTH and a cortisol level is checked within 30 to 60 minutes. Responders are defined as a greater than 9-mcg/dL increase in cortisol and non-responders as a less than 9-mcg/dL increase in cortisol. Septic shock patients refractory to resuscitation and vasopressors, and with adrenal insufifidency (non-responders to the ACTH test) should be administered intravenous hydrocortisone 200 to 300 mg per day in three divided doses for 7 days.24,44... 

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