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Frontiers in Endocrinology 2021Adrenocorticotropic hormone (ACTH) is produced from proopiomelanocortin, which is predominantly synthetized in the corticotroph and melanotroph cells of the anterior and... (Review)
Review
INTRODUCTION
Adrenocorticotropic hormone (ACTH) is produced from proopiomelanocortin, which is predominantly synthetized in the corticotroph and melanotroph cells of the anterior and intermediate lobes of the pituitary gland and the arcuate nucleus of the hypothalamus. Although ACTH clearly has an effect on adrenal homeostasis and maintenance of steroid hormone production, it also has extra-adrenal effects that require further elucidation.
METHODS
We comprehensively reviewed English language articles, regardless of whether they reported the presence or absence of adrenal and extra-adrenal ACTH effects.
RESULTS
In the present review, we provide an overview on the current knowledge on adrenal and extra-adrenal effects of ACTH. In the section on adrenal ACTH effects, we focused on corticosteroid rhythmicity and effects on steroidogenesis, mineralocorticoids and adrenal growth. In the section on extra-adrenal effects, we have analyzed the effects of ACTH on the osteoarticular and reproductive systems, adipocytes, immune system, brain and skin. Finally, we focused on adrenal insufficiency.
CONCLUSIONS
The role of ACTH in maintaining the function of the hypothalamic-pituitary-adrenal axis is well known. Conversely, if we broaden our vision and analyze its role as a potential treatment strategy in other conditions, it will be evident in the literature that researchers seem to have abandoned this aspect in studies conducted several years ago. We believe it is worth re-evaluating the role of ACTH considering its noncanonical effects on the adrenal gland itself and on extra-adrenal organs and tissues; however, this would not have been possible without the recent advances in the pertinent technologies.
Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Animals; Humans; Pituitary-Adrenal System
PubMed: 34489864
DOI: 10.3389/fendo.2021.701263 -
Deutsches Arzteblatt International Mar 2014
Topics: Adrenal Insufficiency; Fluid Therapy; Hormone Replacement Therapy; Humans; Hydrocortisone
PubMed: 24739886
DOI: 10.3238/arztebl.2014.0224b -
Hormone and Metabolic Research =... Aug 2022The coronavirus disease 2019 (COVID-19) pandemic is currently one of the major health concerns worldwide accounting for many deaths and posing a great social and... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic is currently one of the major health concerns worldwide accounting for many deaths and posing a great social and economic burden. Early activation of adrenal hormone secretion is pivotal to surviving systemic microbial infections. In addition, clinical studies demonstrated that glucocorticoids might also be beneficial in reducing disease progression and life deterioration in certain patients with COVID-19. Recent studies demonstrated that SARS-CoV-2 might target the adrenal glands, raising the possibility that at least some COVID-19 complications may be associated with adrenal dysfunction. Whether SARS-CoV-2 infection might cause adrenal dysfunction remains unknown. Histopathological examinations provided evidence that SARS-CoV-2 infection might indeed cause certain structural damage to the adrenal glands, especially concerning its vascular system. However, since no widespread cellular damage to cortical cells was observed, it is less likely that those changes could lead to an immediate adrenal crisis. This assumption is supported by the limited number of studies reporting rather adequate cortisol levels in patients with acute COVID-19. Those studies, however, could not exclude a potential late-onset or milder form of adrenal insufficiency. Although structural damage to adrenal glands is a rarely reported complication of COVID-19, some patients might develop a critical illness-related corticosteroid insufficiency (CIRCI), or iatrogenic adrenal insufficiency resulting from prolonged treatment with synthetic glucocorticoids. In this mini-review article, we aimed at describing and discussing factors involved in the adrenal gland function and possible dysfunction during COVID-19.
Topics: Adrenal Glands; Adrenal Insufficiency; COVID-19; Glucocorticoids; Humans; Pandemics; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 35944524
DOI: 10.1055/a-1873-2150 -
Revista Da Associacao Medica Brasileira... Nov 2016Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. (Review)
Review
INTRODUCTION:
Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably.
OBJECTIVE:
To alert all health professionals about the diagnosis and correct treatment of this complication.
METHOD:
We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic.
RESULTS:
Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests.
CONCLUSION:
Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.
Topics: Acute Disease; Addison Disease; Adrenal Insufficiency; Clinical Protocols; Diagnosis, Differential; Emergency Medical Services; Humans; Hypotension
PubMed: 27992012
DOI: 10.1590/1806-9282.62.08.728 -
Clinical Medicine (London, England) Apr 2008
Topics: Adrenal Insufficiency; Anti-Inflammatory Agents; Dehydroepiandrosterone; Female; Fludrocortisone; Glucocorticoids; Humans; Male; Pregnancy; Prognosis; Quality of Life
PubMed: 18478875
DOI: 10.7861/clinmedicine.8-2-211 -
British Medical Journal Jul 1979
Topics: Addison Disease; Adrenal Glands; Adrenal Insufficiency; Adrenocorticotropic Hormone; Cortisone; History, 20th Century; Humans; Skin Pigmentation
PubMed: 223716
DOI: 10.1136/bmj.2.6181.25 -
Journal of Korean Medical Science Jul 2022
Topics: Adrenal Insufficiency; Humans; Hydrocortisone; Neoplasms
PubMed: 35851865
DOI: 10.3346/jkms.2022.37.e232 -
Frontiers in Endocrinology 2023
Topics: Humans; Adrenal Insufficiency; Hydrocortisone
PubMed: 37124742
DOI: 10.3389/fendo.2023.1180264 -
Journal of Pediatric Nursing 2023
Topics: Humans; Adrenal Insufficiency; Hydrocortisone
PubMed: 37061253
DOI: 10.1016/j.pedn.2023.02.012 -
Medicina (Kaunas, Lithuania) 2002Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or... (Comparative Study)
Comparative Study Review
Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. Although more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are far the most abundant and physiologically active. In primary adrenocortical insufficiency, glucocorticoid and mineral-corticoid properties are lost; however, in secondary adrenocortical insufficiency (i.e., secondary to disease or suppression of the hypothalamic-pituitary axis), mineralocorticoid function is preserved. Every emergency physician should be familiar with adrenocortical insufficiency--a potentially life-threatening entity. The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diagnosis can result in poor patient outcomes. This article review data about physiology, pathophysiology of the adrenal cortex, physiologic effects of glucocorticoids, aldosterone, causes of primary and secondary adrenal insufficiency, frequency, clinical picture, laboratory and imaging studies of adrenal crisis, laboratory evaluation of adrenal function and emergency therapy, replacement therapy, mortality/morbidity of this pathology.
Topics: Acute Disease; Addison Disease; Adrenal Cortex; Adrenal Insufficiency; Adrenalectomy; Adrenoleukodystrophy; Anti-Inflammatory Agents; Critical Care; Female; Humans; Hydrocortisone; Male; Postoperative Complications; Prognosis; Smith-Lemli-Opitz Syndrome; Waterhouse-Friderichsen Syndrome
PubMed: 12474663
DOI: No ID Found