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Patients with hypopituitarism who develop severe insulin sensitivity may require the more basic biochemical replacement ACTH instead of glucocorticoids.
Recent animal studies confirm clinical impressions that ACTH would be more effective as an addition to or replacement of the standard treatment, according to Richard J. Wurtman, MD.
"I am certainly not suggesting that ACTH be adopted once again as the standard replacement..." he explains. Oral hormones and steroids, although bypassing some of the intra-adrenal effects of ACTH, normally suffice.
Occasionally, however, insulin sensitivity in hypopituitarism as well as hypophysectomized persons betrays a disturbance in carbohydrate metabolism that standard corticoid doses will not correct.
A possible explanation is a deficit of epinephrine, the most potent of the naturally-occurring stimuli to the release of blood sugar.
In experiments at the National Institute of Mental Health's Laboratory of Clinical Science, an analog of this clinical problem has been produced by Julius Axelrod,
What Brings on Insulin Sensitivity?. JAMA. 1966;198(1):A50. doi:10.1001/jama.1966.03110140026011