Doses - CORTICOTROPIN (ACTH)

Obtain specific information from the laboratory on sample handling and laboratorynormals for cortisol when doing ACTH stimulation tests. ACTH is quite unstable in unfrozenplasma.

Dogs:

ACTH Stimulation Test:
a) Draw baseline blood sample for cortisol determination and administer 2.2 Units/kg of
ACTH gel IM. Draw sample 120 minutes after injection. (Feldman and Peterson 1984), (Kemppainen and Zerbe 1989b)
b) Draw baseline blood sample for cortisol determination and administer 0.5 Units/kg of
ACTH gel IM. Draw sample 120 minutes after injection.
Normals: Pre-ACTH 1.1-8.0 micrograms/dl; Post-ACTH 6.2-16.8 micrograms/dl.
Hyperadrenocorticism: Pre-ACTH 4.0-10.8 micrograms/dl; Post-ACTH 11.7-50 micrograms/dl.
Hypoadrenocorticism: Pre-ACTH and Post-ACTH: ? 1.0 micrograms/dl. (Morgan 1988)

Cats:

ACTH Stimulation Test:
a) Draw baseline blood sample for cortisol determination and administer 2.2 Units/kg of
ACTH gel IM. Draw samples at 60 minutes and 120 minutes after injection. (Petersonand Randolph 1989), (Kemppainen and Zerbe 1989b)
b) Draw baseline blood sample for cortisol determination and administer 0.5 Units/kg of
ACTH gel IM. Draw sample 120 minutes after injection.
Normals: Pre-ACTH 0.33-2.6 micrograms/dl; Post-ACTH 4.8-7.6 micrograms/dl.
Hyperadrenocorticism: Pre-ACTH 4.0-10.8 micrograms/dl; Post-ACTH 11.7-50 micrograms/dl.
Hypoadrenocorticism: Pre-ACTH and Post-ACTH: ? 1.0 micrograms/dl. (Morgan1988)

Cattle:

For ACTH deficiency or for primary bovine ketosis:
a) 200 - 600 Units initially followed by daily or semi-daily dose of 200 - 300 Units(Package Insert; Adrenomone®¯Summit Hill)
b) 200 Units IM daily (Howard 1986)

Horses:

ACTH Stimulation Test:
a) Draw baseline blood sample for cortisol determination and administer 1 Unit/kg IM of
ACTH gel. Draw second sample 8 hours later. Normal stimulation will result in serumcortisol levels will increase 2-3 times. Horses with pituitary tumors will increase cortisolfourfold after ACTH. (Beech 1987b)

Birds:

ACTH Stimulation Test:
a) Draw baseline blood sample for corticosterone (not cortisol) determination and administer 16 - 25 Units IM. Draw second sample 1-2 hours later. Normal baseline corticosterone levels vary with regard to species, but generally range from 1.5 - 7 ng/ml.
After ACTH, corticosterone levels generally increase by 5 - 10 times those of baseline.
Specific values are listed in the reference. (Lothrop and Harrison 1986)
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products:
Corticotropin, Repository for Injection; 40 Units/ml and 80 Units/ml in 5 ml an d10 ml vials;
ACTH Gel (Anthony); Adrenomone® (Summit Hill) (Rx) Approved for use in dogs, cats, andbeef or dairy cattle.

Human-Approved Products:

Corticotropin Powder for Injection; 25 Units per vial, and 40 Units per vial
Acthar® (Rorer) (Rx) ACTH ®(Parke-Davis); (Rx); generic (Rx)
Corticotropin, Repository for Injection; 40 Units/ml and 80 Units/ml in 1 ml and 5 ml vials
H.P. Acthar® Gel (Rorer) (Rx), ACTH-80®(Various); (Rx)