ANGIOTENSIN CONVERTING ENZYME ACE

Also Known As:  ACE Test, SACE, Serum Angiotensin Converting Enzyme

What Is An Angiotensin Converting Enzyme Test?

The ACE test measures the angiotensin-converting enzyme level in the blood. 
An angiotensin-converting enzyme is a form of enzyme that facilitates and regulates your blood pressure. An increase in ACE level is usually found in patients with Sarcoidosis. It is a systemic disease affecting the lungs and other body organs, including skin, eyes, nerves, heart, and liver. 

The most classic symptom of Sarcoidosis is the production and development of granulomas. These granulomas are small tumor-like masses of inflammatory and immune cells mixed with fibrous tissues forming nodules under your skin and throughout body organs. When it happens, the granulomas alter the structure of the tissues present around them, which ultimately cause damage, inflammation, and interference with normal body functions. 

The cells present at the external border of granulomas can also produce an increased amount of angiotensin-converting enzyme. It can also happen when Sarcoidosis related granulomas develop in sufficient amounts within your bloodstream.

What Is The Test Used For?

The angiotensin-converting-enzyme test or ACE test is usually ordered by a doctor or health care professional to diagnose and monitor a specific disorder known as Sarcoidosis. 
They will most commonly order it as a part of your routine examination to rule out or interpret chronic symptoms due to Sarcoidosis. Sarcoidosis is a disorder in which small nodules known as granulomas form under your skin and other body organs. When Sarcoidosis is present, you are likely to have an increased amount of ACE in your bloodstream. These blood levels of angiotensin-converting enzyme tend to fall and rise with this disorder's activity. 

Suppose the enzyme is initially more in a person with Sarcoidosis. In that case, the test results can scrutinize the course of the disease and the effectiveness of the ongoing corticosteroid treatment. In some cases, your doctor or health care provider will order the test in combination with other related tests, including the AFB test, to detect fungal and mycobacterial infections. Doing so can help them differentiate between Sarcoidosis and any other medical condition causing granuloma formation.

Why And When Do You Need An Angiotensin Converting Enzyme Test?

You might need to undergo an angiotensin-converting enzyme test if you show symptoms of Sarcoidosis. Some of the most common symptoms include:

• Fever
• Cough and wheezing
• Shortness of breath
• Chest pain
• Fatigue and extreme tiredness
• Stiff and sore joints
• Unexplained weight loss
• Loss of appetite
• Headache
• Eyesight problems
• Extremely dry mouth
• Unusual skin changes like skin rashes, sores, and hardened spots
• Nosebleeds
• Night sweats
• Fever
• Swollen lymph nodes

Sarcoidosis can cause the formation of granulomas in the body, leading to organ inflammation. Some organs commonly affected by Sarcoidosis include:

• Liver
• Lungs
• Skin
• Spleen
• Lymph nodes
• Eyes
• Heart

The granulomas linked with the presence of Sarcoidosis will gradually increase the amount of angiotensin-converting enzyme in your blood. This test is used for the assessment and effectiveness of treatment against certain medical conditions. In some cases, these health concerns can also cause low levels of the angiotensin-converting enzyme such as:

• Chronic obstructive pulmonary disease, also known as COPD
• Emphysema
• Hypothyroidism
• Cystic fibrosis

Conditions that may cause higher than normal levels of the angiotensin-converting enzyme are:

• Gaucher's disease
• Cirrhosis
• Amyloidosis
• Psoriasis
• HIV
• Diabetes
• Leprosy
• Hyperthyroidism
• Histoplasmosis
• Tuberculosis

What Kind Of Sample Is Required For The Test?

During the ACE test, a health care provider or lab technician will take a small blood sample from a vein in your arm. The doctor will put a tight bandage around your arm to make your veins visible to take your blood. 

After cleaning the desired area with an antiseptic, he will insert the needle and collect the blood in a tube for a vial attached at the end. Once enough blood is collected in the vial, he will remove the needle and bandage over the puncture site.

Do You Need To Prepare For The Test?

Before going for the test, it is better to follow your doctor's or health care provider's instructions regarding eating or drinking for up to 12 hours. If you are taking any supplements or steroid medicines, always ask your practitioner if you need to stop consuming the drug before the test, as they can alter the angiotensin-converting enzyme test results.

Are There Any Risks To This Test?

This test carries few to almost zero risks. You might feel a slight bruising or soreness around the area where the needle was inserted, but it will go away on its own within a few hours. However, it is suggested that you call your doctor if you suspect severe discomfort, bruising, or pain after giving out the blood sample. Some other serious complications that might occur with this blood test include:

• Severe infection at the puncture site.
• Unstoppable bleeding.
• Fainting or feeling dizziness.
• Accumulation of blood under the skin is called a hematoma.

What Do The Test Results Mean?

The normal ACE values depend upon the test method used, your age, and the severity of symptoms. A normal adult should have less than 40 micrograms/L of ACE level in blood. Know that normal values might differ slightly among Laboratories as they all use different measurement techniques for different samples.

Higher than the normal angiotensin-converting enzyme levels is an indication of Sarcoidosis. The levels may fall or rise depending upon the worsening and improvement in your condition. Higher ACE levels are also indicators of other disorders and diseases like:

• Diabetes
• Hodgkin's disease or cancer of the lymph tissues
• Kidney disorders such as Nephrotic syndrome
• Liver swelling and inflammation, i.e., hepatitis due to excessive alcohol use
• Lung diseases like cancer, asthma, tuberculosis, and chronic obstructive pulmonary disease
• Addison's disease in which adrenal glands cannot make enough hormones
• Multiple sclerosis
• Overactive thyroid or hyperthyroidism
• Stomach ulcer
• Hyperparathyroidism or overactive parathyroid glands

Lower than normal angiotensin-converting enzyme levels may demonstrate:

• Underactive thyroid or hypothyroidism
• Chronic kidney failure
• Chronic liver diseases
• Therapy for Sarcoidosis
• Steroid therapy usually with prednisone
• Eating disorder, i.e., anorexia nervosa

Related Tests:   CT scan, Chest X-Ray, Sputum Culture, Tissue Biopsy, Acid-Fast Bacillus (AFB) Testing, Complete Blood Count (CBC Blood Test), Hepatic Function Panel, Calcium

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on June 04, 2023. 

References

Angiotensin-converting enzyme (ACE) inhibitors

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480

Angiotensin-Converting Enzyme Inhibitors (ACEI) - StatPearls - NCBI Bookshelf (nih.gov)

https://www.ncbi.nlm.nih.gov/books/NBK431051/