코르티코트로핀 (ACTH)

호르몬 진단제

코르티코트로핀(ACTH)은 뇌하수체 전엽에서 분비되는 39개의 아미노산으로 구성된 폴리펩타이드 호르몬입니다. 수의학에서는 주로 부신 기능을 평가하기 위한 **진단제**로 사용됩니다. - **주요 용도**: ACTH 자극 시험은 부신피질 기능 저하증(애디슨병)을 진단하고, 의인성 부신피질 기능 항진증(쿠싱 증후군)을 식별하며, 부신 억제 치료(예: 미토탄 또는 트릴로스탄)의 효과를 모니터링하는 데 사용됩니다. - **한계점**: 개에서 자연적으로 발생하는 쿠싱 증후군을 선별하는 검사로는 저용량 덱사메타손 억제 시험(LDDST)에 비해 민감도가 상대적으로 낮습니다. - **임상 팁**: 천연 돼지 ACTH 겔 제품의 높은 비용, 제한된 공급 및 역가의 변동성 때문에, 현대 임상에서는 ACTH 자극 시험에 합성 **코신트로핀(cosyntropin)**을 사용하는 것이 더 선호됩니다.

작용 기전: Endogenous ACTH release is controlled by corticotropin-releasing factor (CRF) from the hypothalamus and is subject to negative feedback by glucocorticoids. Exogenous corticotropin binds to **melanocortin-2 receptors (MC2R)** in the **zona fasciculata** of the adrenal cortex $\rightarrow$ stimulates the conversion of cholesterol to pregnenolone via cholesterol desmolase $\rightarrow$ rapidly increases the synthesis and release of **glucocorticoids** (primarily **cortisol** in mammals and **corticosterone** in birds and reptiles).

동물 종별 용량

Cats

ACTH Stimulation Test · 2.2 Units/kg IM · IM · Once · Draw baseline blood sample, administer gel, then draw samples at 60 minutes and 120 minutes after injection.
ACTH Stimulation Test · 0.5 Units/kg IM · IM · Once · Draw baseline blood sample, administer gel, then draw sample 120 minutes after injection.

Cattle

ACTH deficiency or primary bovine ketosis · 200-600 Units initially followed by daily or semi-daily dose of 200-300 Units · IM · daily or semi-daily

Horses

ACTH Stimulation Test · 1 Unit/kg IM · IM · Once · Draw baseline blood sample, administer gel, then draw second sample 8 hours later.
ACTH Stimulation Test · 1 Unit/kg IM · IM · Once · Administer between 8 and 10 AM; take post ACTH cortisol levels at 2 and 4 hours post dose.

Birds

ACTH Stimulation Test · 16-25 Units IM · IM · Once · Draw baseline blood sample for corticosterone (not cortisol), administer IM, draw second sample 1-2 hours later.

Dogs

ACTH Stimulation Test · 2.2 Units/kg IM · IM · Once · Draw baseline blood sample, administer gel, then draw second sample 120 minutes after injection.

투여 경로

금기

Hypersensitivity to porcine proteins
Intravenous (IV) administration of the repository gel formulation

이상반응

Fluid and electrolyte disturbances (with prolonged/chronic use)
Hypersensitivity reactions (rare)

약물 상호작용

Anticholinesterases (e.g., pyridostigmine) · May antagonize effects in patients with myasthenia gravis
Diuretics · May increase electrolyte loss (e.g., hypokalemia) if used chronically
Glucocorticoids (hydrocortisone, cortisone) · Exogenous administration on the day of the test will cross-react with cortisol assays and invalidate test results

모니터링

Serum cortisol levels (pre- and post-injection for mammals)
Serum corticosterone levels (pre- and post-injection for birds/reptiles)
Electrolytes and fluid balance (only if used chronically)

과용량

When used for diagnostic purposes, acute inadvertent overdoses are highly unlikely to cause any significant adverse effects. Monitor the patient as required and treat symptomatically if necessary.

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