FDA-APPROVED INDICATIONS OF ADRENOCORTICOTROPIC HORMONE (ACTH) AS A DRUG: DOES IT HAVE A PLACE IN DISEASE MANAGEMENT TODAY?

ACTH is a pituitary hormone important for proper function of adrenal glands, cortisol production as well as human physiology in general.  It is involved in the pathogenesis of several endocrine disorders like Cushing syndrome and can be a useful diagnostic tool for diseases like primary adrenal insufficiency.  Although popular as a hormone in endocrine system physiology and testing, ACTH has been used as a drug since the 1950s.  Except for steroid-releasing properties, its mechanism of action involves a steroid-independent anti-inflammatory and possible immune-modulatory effect.  Pharmaceutic ACTH has a wide range of indications approved by FDA and usually comes in the form of subcutaneous injections.  In this narrative review, we accumulated what we considered as important data from reviews, cases and trials involving the most basic FDA-approved ACTH indications.  A special emphasis was given on rheumatologic indications of ACTH.  More large data studies need to be performed to assess ACTH usefulness, efficacy, safety and cost-effectiveness as a drug.