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Peptide

Corticorelin Ovine (Acthrel)

Corticorelin is a synthetic ovine corticotropin-releasing hormone (CRH) analog. FDA-approved for differentiating pituitary vs ectopic ACTH in Cushing's syndrome. 88% sensitivity, 100% specificity for Cushing's disease when using cortisol response criteria. Ovine CRH superior to human CRH. Positive response: >35% ACTH increase and >20% cortisol increase.

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Best evidence
Grade A
Conditions studied
1
Outcomes
3
Graded outcomes
3000

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

1 condition

Cushing's Syndrome

Cushing's Syndrome: outcomes studied for Corticorelin Ovine (Acthrel)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Cushing's Disease Diagnosis

CRH test sensitivity 86-93%, specificity 90-100% for Cushing's disease. 93/100 patients with Cushing's disease showed ≥35% ACTH increase, 0/16 with ectopic ACTH. Superior to dexamethasone suppression test (91% vs 75% accuracy).

Improves (the measure goes up)Large effect9 studies

Studies that measured cushing's disease diagnosis

ACTH/Cortisol Response

Positive criteria: ≥35-40% ACTH increase and/or ≥20% cortisol increase. ≥40% cortisol increase most specific (PPV 99%). Peak response at 15-30 minutes. Absent response in ectopic ACTH syndrome.

Changes; see studiesLarge effect9 studies

Studies that measured acth/cortisol response

Ectopic ACTH Exclusion

Ectopic ACTH tumors fail to respond to CRH stimulation. 0% of ectopic ACTH patients show positive response. False negative rate in Cushing's disease 5-10%. Ovine CRH preferred over human CRH for higher sensitivity.

Improves (the measure goes up)Large effect8 studies

Studies that measured ectopic acth exclusion

Key findings

  • Cushing's Disease DiagnosisCushing's SyndromeImproves (the measure goes up)
  • ACTH/Cortisol ResponseCushing's SyndromeChanges; see studies
  • Ectopic ACTH ExclusionCushing's SyndromeImproves (the measure goes up)

Studies cited

4 studies from PubMed

  1. The corticotropin-releasing hormone test in the diagnosis of ACTH-dependent Cushing's syndrome: a reappraisalJ Clin Endocrinol Metab, 2001 · PMID 11380490
  2. A simplified morning ovine corticotropin-releasing hormone stimulation test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndromeJ Clin Endocrinol Metab, 1993 · PMID 8077325
  3. The ovine corticotropin-releasing hormone (CRH) stimulation test is superior to the human CRH stimulation test for the diagnosis of Cushing's diseaseJ Clin Endocrinol Metab, 1989 · PMID 2543689
  4. The ovine corticotropin-releasing hormone stimulation test and the dexamethasone suppression test in the differential diagnosis of Cushing's syndromeAnn Intern Med, 1986 · PMID 3022629