Effects of pituitary adrenocorticotrophic hormone (ACTH) in panhypopituitarism of long-standing and in myxedema

Abstract

The metabolic changes observed in a patient with long-standing hypopituitarism and presumed atrophy of the adrenal glands during ten days of ACTH administration were minimal. Retention of sodium and chloride, some increase in 17-ketosteroid excretions, in uric acid excretion and an unexplained rise in basal metabolism were noted. No alteration in carbohydrate or nitrogen metabolism was observed. The metabolic changes observed in a patient with primary myxedema during eight days of ACTH administration were comparable to those observed in the same patient during a second period of seven days of ACTH administration after euthyroidism had been achieved. Hence the presence of a normal thyroid function is not essential to the function of ACTH. Increased potassium excretion, a negative nitrogen balance, increased uric acid excretion, and increased 17-ketosteroid and “corticoid” excretion were observed in both studies. A greater weight gain and retention of sodium and chloride were observed in the study made before thyroid treatment was instituted. In both, changes in carbohydrate metabolism were equivocal. While myxedematous the initial injection of ACTH was accompanied by a less than normal fall in circulating eosinophiles, although these cells subsequently disappeared from the blood with continued hormone administration. ACTH resulted in no significant alteration in thyroid function in either study. Mild but consistent hypertension appeared in both studies during ACTH administration.