abnormalities of ACTH.pptx

ACTH is a polypeptide tropic hormone.
Produced by the pituitary gland in the brain.
Composed of 39 Amino acid.
It has a molecular weight of 4540 Da.
Stimulate the adrenal glands to produce and release cortisol into the bloodstream.

1. University of Chakwal, Pakistan

2. Topic: Abnormalities of ACTH Department of Zoology
Presented by: Komal Zahra
Roll no# UOC-BSZOL-F2020/035
BS Zoology
Session: 2020-2024
Subject: Endocrinology
Instructor Name: Dr. Syeda Nadia Ahmad

3. ACTH : ACTH is a polypeptide tropic hormone. Produced by the pituitary gland in the brain. Composed of 39 Amino acid. It has a molecular weight of 4540 Da. Stimulate the adrenal glands to produce and release cortisol into the bloodstream. ( Cuijpers P.,2019). Figure #1: ACTH https://images.app.goo.gl/EzMFgFmSbeSG8NuL8

4. Regulation of ACTH: ACTH (adrenocorticotropic hormone) is controlled by the hypothalamus-pituitary-adrenal (HPA) axis.
The hypothalamus releases corticotropin -releasing hormone (CRH),
which signals the pituitary gland to produce and release ACTH.
ACTH then stimulates the release of CRH and ACTH is regulated by a feedback loop. When cortisol levels are high, they inhibit the release of CRH and ACTH, helping to maintain a balance in the body’s stress response(Caldwell H.K.,2018).

5. Regulation of ACTH : Conversely, when cortisol levels are low, the hypothalamus and pituitary release more CRH and ACTH to stimulate cortisol production.
The adrenal glands to produce and release cortisol(Caldwell H.K.,2018). Figure #2: HPA axis https://images.app.goo.gl/Zn8KCRquxSZKxwoe9

6. Normal Range: Like cortisol, the level of ACTH in your blood normally peaks in the early morning and declines throughout the day, reaching its lowest level around midnight. Normal ACTH levels in the blood are generally between 9 and 52 picograms per milliliter ( pg /mL)(Kirsch P.,2017).

7. Hyper-secretions of ACTH: High ACTH levels are often associated with increased cortisol productions. Hyper-secretions of ACTH results: Cushing’s Disease/syndrome Nelson Syndrome Ectopic ACTH tumor Production(Hiroi, N.,etal.2020)

8. Cushing Syndrome : Cushing’s syndrome is a condition characterized by prolonged exposure to high levels of ACTH. A benign (non-cancerous) tumor (adenoma) in your pituitary gland that produces excess amounts of ACTH, which then elevates cortisol levels(Cid-joffre,etal.,2020). Figure #3: Cushing syndrome https://images.app.goo.gl/1tcM4ZxGwTjTTg6N7

9. Cushing Syndrome: Symptoms of Cushing’s Syndrome: Weight Gain
Skin Changes
Muscle Weakness
High Blood Pressure
Glucose Intolerance
Irregular Menstrual Periods
Emotional Changes
Increased thirst and urination.

10. Treatment : Treatment involves surgery to remove the pituitary tumor, if possible. After surgery, the pituitary gland may slowly start to work again and return to normal. Radiation treatment of the pituitary gland may also be used if the tumor is not completely removed. Medication (Carter,etal.2019).

11. Ectopic ACTH Tumor: An ectopic ACTH tumor refers to a tumor outside the pituitary gland That produces high level of adrenocorticotropic hormone (ACTH). This can lead to increased cortisol production. It is rare, and between 10% and 20% of Cushing’s syndrome (CS) could be found associated with an ectopic tumor. Symptoms same like Cushing’s syndrome Tumors that can produce ACTH include:

12. Ectopic ACTH tumor: Benign carcinoid tumors of the lung,
Islet cell tumors of the pancreas, Medullary carcinoma of the thyroid,
Small cell tumors of the lungs
And tumors of the thymus gland Treatment include: Surgery, Chemotherapy, Radiation Therapy, Medications and supportive care(Liddle, G. W.etal,2017).

13. Nelson syndrome: Enlarging tumor in the pituitary gland, named after the endocrinologist Don Nelson who described the condition in 1958. The tumor produces an excess of a hormone called ACTH hormone, which is involved in the production of other steroid hormones (such as cortisol). Large tumors invade areas around the pituitary gland, which may cause a reduction in levels of other hormones. The enlarged tumor compresses the rest of the pituitary gland(Cable & Grider,.2020).

14. The tumour can also grow upwards from the pituitary gland and compress vital nerves involved in vision. Symptoms of Nelson Syndrome: Hyperpigmentation Visual Disturbances Headaches Fatigue and Weakness Treatment Options: Surgery, Radiation Therapy, Medication and Regular Monitoring. Figure #4 : Pituitary Tumor https://images.app.goo.gl/zXfczn4CTYp8Bh499

15. High level of ACTH in pregnancy : The high secretion of ACTH at the beginning of the last trimester of pregnancy may stimulate the development of the adrenal cortex And result in the increased cortisol secretion necessary for fetal lung maturation. Placental CRH stimulates the production of maternal adrenocorticotropin hormone (ACTH) and cortisol, leading to substantial increases in maternal serum cortisol levels during the third trimester.

16. Hypo-secretion of ACTH: Hyposecretion in which low level of ACTH production. The diseases include: Hypopituitarism Addison Disease

17. Hypopituitarism: This is a rare condition in which there’s a lack (deficiency) of one, multiple or all of the hormones made by your pituitary gland. ACTH can be one of the affected hormones. Any type of damage to your pituitary gland, such as pressure on the gland, surgical damage or radiation therapy, can cause hypopituitarism.
Hypopituitarism can affect anyone at any age. There are approximately 10 to 40 new cases per one million people a year(Cassata,.2021).

18. Symptoms : Fatigue, Weight loss or gain, Changes in appetite and metabolism, Weakness especially in muscles, Decreased libido, Irregular or absent menstrual periodsin In women, Infertility, Sensitivity to cold or difficulty staying warm, Affecting thyroid hormone levels, Low blood pressure, Joint pain and Headaches. Treatment: Some hormone replacement therapies, Corticosteroids. Figure #5: Hypopituitarism https://images.app.goo.gl/dH3BYDGREHLuj78k8

19. Addison Disease: Addison Disease occur due to low level of ACTH. Symptoms of Addison’s Disease: Fatigue, Weight loss, Low Blood pressure, Skin changes and Hyperpigmentation. Treatment : Hormone replacement therapy with glucocorticoids, such as hydrocortisone(Ray,.2019). Figure #6: Addison ‘s disease https://images.app.goo.gl/UpMfSgXAEahRrucW9

20. ACTH Test: The ACTH test measures adrenocorticotropic hormone levels in the blood. ACTH Test Procedure: The ACTH test typically involves drawing blood, usually in the morning when cortisol levels peak and then blood samples are taken to observe the adrenal gland’s response. Figure #7: ACTH test https://images.app.goo.gl/vkRKqMtk9e34Edq67

21. Results Interpretation: Normal Results: Adequate cortisol production after ACTH stimulation Low ACTH Levels: Possible adrenal insufficiency or Addison’s disease. High ACTH Levels: Suggestive of conditions like Cushing’s syndrome,or a pituitary gland issue(May, M. E.,etal.2019).

22. References: Hiroi, N., Yakushiji , F., Shimojo , M., Watanabe, S., Sugano, S., Yamaguchi, N., & Miyachi , Y. (2020). Human ACTH hypersensitivity syndrome associated with abnormalities of the ACTH receptor gene. Clinical Endocrinology, 48(2), 129-134.
May, M. E., & Carey, R. M. (2019). Rapid adrenocorticotropic hormone test in practice. Retrospective review. The American journal of medicine, 79(6), 679-684.
Liddle, G. W., Givens, J. R., Nicholson, W. E., & Island, D. P. (2017). The ectopic ACTH syndrome. Cancer Research, 25(7_Part_1), 1057-1061.