CORTROSYN DEPOT(cosyntropin)
Cosyntropin is a synthetic derivative of adrenocorticotropic hormone (ACTH) that is used in the ACTH stimulation test to evaluate and diagnose cortisol disorders. Cosyntropin contains only the first 24 (of a total 39) amino acids of ACTH but retains full function.
In patients with low cortisol levels or symptoms of adrenocortical insufficiency, cosyntropin can be used to diagnose Addison's disease. A failure for serum cortisol levels to increase after administration of cosyntropin makes a diagnosis of primary adrenocortical insufficiency more likely. An increase in cortisol upon administration of cosyntropin rules out the condition. The test may also be used to assess the function of the adrenal glands after successful treatment for Cushing's syndrome.
Cosyntropin is also used in the opposite situation, when there is aldosterone hypersecretion due to either a unilateral adrenal adenoma (which is treated by surgical removal) or bilateral adrenal hyperplasia (treated by oral spironolactone). A procedure called adrenal venous sampling may be used pre-operatively to localize the source of aldosterone hypersecretion from either adrenal gland. A peripheral intravenous infusion of Cosyntropin before and during the procedure stimulates cortisol production and thereby verifies catheter position.
Synthetic ACTH:  An active synthetic form of ACTH, consisting of the first 24 amino acids of native ACTH, was first synthesized by Klaus Hofmann at the University of Pittsburgh. ACTH is available as a synthetic derivative in the forms of cosyntropin, tradename Cortrosyn, and synacthen (synthetic ACTH). Synacthen is not FDA approved but is used in the UK and Australia to conduct the ACTH stimulation test.
ACTH was first synthesized as a replacement for Acthar Gel, a long-lasting animal product used to treat infantile spasms. Once relatively inexpensive, Acthar Gel is currently an extremely expensive pharmaceutical product. Prices per vial have been as high as $27,000. Acthar gel has been proposed as a therapy to treat refractory autoimmune diseases and refractory nephrotic syndrome due to a variety of glomerular diseases.

分类名称:
一级分类：内分泌系统药物 二级分类：下丘脑及影响内分泌的药物
药物剂型:
1.注射剂（Cortrosyn)：250μg(1ml)，供静脉注射和肌内注射用；
2.长效注射剂（Cortrosyn Depot)：1mg(1ml)，仅供肌内注射。
药理作用:
本品作用与促肾上腺皮质激素相同，可刺激肾上腺皮质分泌皮质激素（主要是皮质醇)，因此对肾上腺皮质功能严重低下者无效。
药动学:
为人工合成的24个氨基酸组成的多肽。其结构和促肾上腺皮质激素的第1个～第24个氨基酸相同。静脉给药可迅速升高血皮质醇水平，需维持血皮质醇浓度时应持续静脉点滴给药。肌内注射，血皮质醇于注射后1h达到高峰。以后可使升高的皮质醇维持约24h。
适应症:
本品与促肾上腺皮质激素的作用相同。因此，其临床应用范围与促肾上腺皮激素相似。由于相同的用药指征多选用作用更强、副作用较小的皮质激素。因此，本品目前仅用于部分克罗恩病或溃疡性结肠炎和风湿性关节炎等少数疾病。长期应用皮质激素治疗的患者可联合使用本品，以预防肾上腺萎缩。本品和促肾上腺皮质激素一样也用于肾上腺皮质功能检查。但长效替可克肽一般不作为标准的肾上腺皮质功能试验用药。
禁忌症：
不宜用于结核病、高血压、糖尿病、溃疡病和孕妇。
不良反应：
与促肾上腺皮质激素相同。大量使用可引起水钠潴留和高血压、精神异常、糖耐量异常、蛋白质消耗、骨质疏松、低血钾、月经异常、色素沉着和痤疮等。少数患者可对本品出现过敏反应，但发生率较促肾上腺皮质激素少。
用法用量：
本品1mg相当于促肾上腺皮质激素100U，作为治疗用多采用本品的长效制剂。
1.长效替可克肽成人的常用剂量是每天肌内注射1mg，当急性症状被控制后可减为每2～3天肌内注射1mg，稳定后可每2～3天肌内注射500μg，或每周肌内注射1mg。
2.儿童的维持剂量是：2岁以内每2～8天250μg；5～12岁每2～8天为250μg～1mg。剂量应根据不同疾病以及个体的反应而定。
专家点评：
用于肾上腺皮质功能检查，正常人肌内注射或静脉注射本品250μg，30min或60min后的血皮质醇浓度不低于150μg/L（428nmol/L)，或较注射前增加50μg/L。如结果可疑，未能作出诊断时，可肌内注射长效24替可克肽1mg，正常人于注射后5h，血皮质醇浓度可逐渐升高至1000～1800nmol/L。
规格
0.25mg 5支 x 1ml 
1mg/ml  10支 （长效）