MON-504 - Comparison of Standard- and Low-dose Acton Prolongatum-stimulated Blood Steroid Profiling in Reproductive-Age Indian Women: A Pilot Study

Comparison of Standard- and Low-dose Acton Prolongatum-stimulated Blood Steroid Profiling in Reproductive-Age Indian Women: A Pilot Study

Background
Adrenocorticotropic hormone (ACTH) stimulation testing is central to the assessment of adrenal reserve and steroidogenesis. Acton prolongatum (AP), a long-acting porcine sequence ACTH, is a commonly used alternative for synacthen (ACTH 1-24) in India. Although low-dose AP has been shown to elicit cortisol responses comparable to standard-dose AP, its ability to stimulate a broader adrenal steroid profile remains uncertain. We aimed to compare low-dose and standard-dose AP-stimulated steroid responses in healthy reproductive-age Asian Indian women.
Methods

This prospective two-phase crossover study included 15 apparently healthy women aged 18–40 years. Participants underwent stimulation with low-dose (6 IU; 62.5 µg) and standard-dose (24 IU; 250 µg) intramuscular AP, with a washout period of at least 4 weeks between phases. Blood samples were collected at baseline and 60 minutes after stimulation. Serum concentrations of 13 steroids, including cortisol, cortisone, corticosterone, aldosterone, 11-deoxycorticosterone, 11-deoxycortisol, 21-deoxycortisol, 17-hydroxyprogesterone (17OHP), dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, progesterone, and testosterone, were measured by liquid chromatography-tandem mass spectrometry (LC–MS/MS). Data were expressed as median (range).
Results
Baseline serum steroid concentrations were comparable between the low-dose and standard-dose phases for all analytes. Serum concentrations after stimulation with low- and standard-dose AP were comparable for all measured steroids, including cortisol [256.0 (188–377) vs 273.0 (177–339) ng/ml, p=0.384] and 17OHP [0.95 (0.51-1.51) vs 1.00 (0.65-2.0) µg/L p=0.1]. The percentage changes in serum levels of all the measured steroids after stimulation with low- and standard-dose AP were also comparable.
Conclusions
Stimulation with low-dose and standard-dose AP produced comparable responses for all LC–MS/MS-measured steroids in healthy reproductive-age Asian Indian women. These findings suggest that low-dose AP may be adequate for ACTH-stimulated adrenal steroid profiling. However, larger studies are warranted to validate the study's observations.

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