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Adrenocorticotropic Hormone ACTH

Also Known as: Corticotropin, Adrenocorticotropic Hormone

What is an adrenocorticotropic hormone (ACTH) test?

The adrenocorticotropic hormone (ACTH) level in the blood is measured with this test. ACTH is produced by the pituitary gland, a tiny gland located near the base of the brain. ACTH regulates the production of cortisol, which is another hormone released by the adrenal glands, positioned above the kidneys, playing a critical role in assisting the body to control blood sugar levels, keeping blood pressure in check, regulating metabolism, and reacting to stress and infection. Conditions affecting the hypothalamus, pituitary, or adrenal glands can disrupt the regulation of ACTH and cortisol production resulting in signs and symptoms linked with cortisol overproduction or insufficiency. Cushing disease, adrenal insufficiency (Addison disease), and hypopituitarism are all conditions that impact ACTH. Some tumors outside of the pituitary, such as those in the lungs, can also produce ACTH, which raises cortisol levels. Cortisol levels that are too high or too low might cause significant health concerns.

What is the test used for?

To diagnose diseases of the pituitary or adrenal glands, an ACTH blood test is sometimes performed in combination with a cortisol test. The diseases covered are:

  • Cushing's syndrome: a condition in which the adrenal gland produces excessive amounts of cortisol. An underlying tumor usually causes this in the pituitary gland or the use of certain steroid medications, which are typically used to treat inflammation but may have cortisol-lowering adverse effects.

  • Cushing's disease: a type of Cushing's syndrome usually caused by a non-cancerous growth of the pituitary gland producing an excessive amount of ACTH, resulting in overproduction of cortisol that is stimulated from the adrenal glands.  

  • Addison disease: characterized by cortisol deficiency caused by a lack of cortisol production by the adrenal gland.

  • Secondary adrenal insufficiency: Due to pituitary dysfunction causing decreased cortisol production

  •  Hypopituitarism: a condition in which there is a lack of production of pituitary hormones. 

Why and when do you need an ACTH Blood test?

Suppose you have signs and symptoms of too much or too little cortisol in the body or when your healthcare provider suspects you have a hormone imbalance caused by an underlying problem in your pituitary or adrenal glands. In that case, they may recommend you to get an ACTH blood test.

Too much cortisol in the body can cause the following symptoms:

  • Gain in weight 

  • Accumulation of fat between the shoulders

  • Presence of Stretch marks (lines) which are often pink or purple on the abdomen, thighs, or breasts 

  • Skin infection 

  • Frequent bruising of fragile skin

  • Increased growth of hair on the body

  • Weakness in muscles 

  • Feeling tired or lethargic

  • Acne on face

Too little cortisol production can cause the following symptoms:

  • Loss of weight

  • Muscle weakness

  • Fatigue 

  • Loss of appetite

  • Vomiting and nausea

  • Diarrhea 

  • Cravings for salt 

  • Pain in the abdomen

  • Dizziness (vertigo ) 

  • Skin discoloration

If you are having symptoms of hypopituitarism, you may also need this test. Symptoms will differ depending on the severity of the disease, but they may include:

  • Loss of appetite

  • Infertility and irregular menstruation in women 

  •  loss of facial and body hair in men

  • Reduced sex drive In both men and women

  • Dysfunction of sex organs 

  • Sensitivity to cold

  • Hot flashes 

  • Frequent urination 

  • Fatigue 

What kind of sample is required for the test?

A healthcare provider will use a small needle to obtain a blood sample from a vein in your arm. A small amount of blood will be collected into a test tube or vial once the needle is inserted. When the needle goes in or out, it may sting a little. It usually takes less than five minutes to complete this process.

Do you need to prepare for the test?

Before the test, you may need to fast (not eat or drink) for the night because cortisol levels may fluctuate throughout the day, so tests are typically performed early in the morning.

Are there any risks to this test?

Having a blood test carries relatively little risk. You may experience minor pain or bruising where the needle was inserted, but most symptoms disappear quickly.

What do the ACTH Blood Test results mean?

ACTH blood test results are frequently compared with cortisol test results and may reveal one of the following diseases upon evaluation involving the adrenal and pituitary glands.

  • Elevated ACTH and cortisol levels may indicate Cushing's disease.

  • Low amounts of ACTH and cortisol could indicate hypopituitarism

  • Low ACTH and high cortisol levels could indicate Cushing's syndrome or an adrenal tumor

  • Addison's disease may be characterized by high ACTH and low cortisol levels

Should you have any questions regarding your test results, you must consult with your healthcare provider. 

Related tests: Cortisol Test, ACTH Stimulation Test, Androstenedione test

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