Corticorelin Ovine

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Corticorelin Ovine Brand Name– Acthrel

What is Corticorelin Ovine

Corticorelin ovine is a peptide isolated from ovine hypothalami, used intravenously as a diagnostic agent in patients with Cushing’s syndrome and adrenal insufficiency.

Corticorelin is used after the establishment of hypercortisolism consistent with the presence of Cushing’s syndrome, when autonomous adrenal hyperfunction has been eliminated as the cause.

Corticorelin allows for the evaluation of the pituitary-adrenal axis in order to differentiate between a pituitary source (i.e., Cushing’s disease) and an ectopic source of excessive ACTH secretion.

As sensitive as a standard dexamethasone test in effectively delineating patients with pituitary Cushing’s disease, the corticorelin stimulation test offers advantages over the dexamethasone test in that it is more convenient and less expensive to administer and requires only the assessment of plasma ACTH and cortisol responses over a few hours.

While it has been suggested that human corticotropin releasing hormone (hCRH) may offer an advantage over ovine-derived corticorelin by being less immunogenic, this has not been substantiated in studies to date, and corticorelin, ovine appears preferable to hCRH as it has proven a more effective stimulus of corticotropin and cortisol secretion, producing greater diagnostic sensitivity.

Corticorelin’s ability to specifically stimulate corticotropin, with minimal adverse sequelae, has made this hormone useful in the evaluation of pituitary-adrenal function in patients with Cushing’s syndrome.

Corticorelin has also been studied in the differential diagnosis of adrenal insufficiency, brain edema, Nelson’s syndrome, chronic fatigue syndrome, depression, and panic disorders.

Corticorelin ovine was FDA-approved in 1996.

Indications

  • Cushing’s syndrome

For the differential diagnosis of pituitary or ectopic production of corticotropin (ACTH) in patients with ACTH-dependent Cushing’s syndrome

Side Effects

  1. angioedema
  2. asystole
  3. dyspnea
  4. flushing
  5. hypotension
  6. sinus tachycardia
  7. syncope
  8. urticaria
  9. wheezing

Monitoring Parameters

  • blood pressure
  • heart rate
  • serum cortisol

Contraindications

  • breast-feeding
  • children
  • dialysis
  • intramuscular administration
  • ovine protein hypersensitivity
  • pregnancy
  • renal failure
  • subcutaneous administration

Interactions

  • Dexamethasone
  • Heparin
  • Vasopressin, ADH

Dexamethasone: (Major) Patients pretreated with dexamethasone have demonstrated an inhibited or blunted response to corticotropin, ovine. Patients receiving corticotropin, ovine should not be pretreated with dexamethasone; no specific guidelines are available. 

Heparin: (Major) The use of a heparin solution to maintain IV cannula patency during corticorelin stimulation tests is not recommended. A possible interaction between corticorelin and heparin may have been responsible for a major hypotensive reaction that occurred after corticorelin administration. 

Vasopressin, ADH: (Major) The coadministration of corticorelin, ovine and vasopressin, ADH has resulted in a synergistic effect on the secretion of corticotropin, with a less marked synergistic response on cortisol secretion. The concomitant use of corticorelin and vasopressin should be avoided. 

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