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Adrenocorticotropic-hormone-acth



Why Get Tested

In conjunction with cortisol testing to help diagnose adrenal gland problems and pituitary diseases such as Cushing syndrome Cushing disease Addison disease adrenal tumors and pituitary tumors

When To Get Tested

When you have signs and symptoms associated with excess or deficient cortisol production when your healthcare provider suspects that you have a hormone imbalance that could be caused by a problem with your pituitary or adrenal glands

Sample Required

A blood sample drawn from a vein in your arm

Test Preparation Needed

The healthcare practitioner may request that you fast overnight before testing Blood is typically drawn in the morning about 8 a m




Common Questions


ACTH blood tests are used usually in conjunction with cortisol tests to help detect diagnose and monitor conditions associated with excessive or deficient cortisol in the body These conditions include Cushing disease excess cortisol that is due to an ACTH-producing tumor in the pituitary gland usually a benign tumor Cushing syndrome refers to the symptoms and signs associated with excess cortisol in addition to Cushing disease Cushing syndrome may be due to an adrenal tumor adrenal hyperplasia the use of steroid medications or due to an ACTH-producing tumor located outside the pituitary ectopic such as in the lungs Addison disease primary adrenal insufficiency decreased cortisol production due to adrenal gland damage Secondary adrenal insufficiency decreased cortisol production because of pituitary dysfunction Hypopituitarism pituitary dysfunction or damage that leads to decreased or no hormone production by the pituitary including ACTH production Measuring both ACTH and cortisol can help to differentiate among some of these conditions because the level of ACTH normally changes in the opposite direction to the level of cortisol If abnormal levels are detected a healthcare practitioner will do additional testing to help confirm the findings and help determine the cause For additional details on these tests read the Cortisol article

An ACTH test may be ordered after a cortisol test reveals abnormal results and when someone has signs or symptoms associated with excess or deficient cortisol Too much cortisol can cause symptoms that include Obesity with majority of the weight on the trunk of the body and not the arms and legs Fat collection between the shoulders Rounded red face Fragile and thin skin Purple lines on the abdomen Muscle weakness Acne Skin infections Increased body hair Fatigue These are often accompanied by findings such as high blood pressure low potassium high bicarbonate high glucose levels and sometimes diabetes People with insufficient cortisol production may exhibit symptoms such as Muscle weakness Fatigue Weight loss Increased skin pigmentation even in areas not exposed to the sun Loss of appetite Diarrhea nausea and vomiting Dizziness Salt cravings These are often accompanied by findings such as low blood pressure low blood glucose low sodium high potassium and high calcium Symptoms suggestive of hypopituitarism typically include several of the following Loss of appetite Fatigue Irregular menstrual cycle Dysfunction of sex organs hypogonadism Decreased sex drive Frequent nighttime urination Unexplained weight loss Hot flashes Cold sensitivity When the condition is due to a pituitary tumor usually benign the affected person may also have symptoms associated with the compression of nearby cells and nerves For example the tumor can cause a change in a pattern of headaches It can also affect the nerves controlling vision causing symptoms such as tunnel vision inability to see things off to the side loss of vision to some localized areas or double vision

In many cases the interpretation of the results can be complex Levels of both ACTH and cortisol vary throughout the day Normally ACTH will be at its highest level in the morning and lowest at night It will stimulate cortisol production which will follow the same daily pattern but will rise after ACTH does and fall to its lowest level very late in the evening Conditions that affect the production of ACTH and cortisol often disrupt this diurnal variation Results of ACTH and cortisol tests are often evaluated together The table below indicates the common patterns of ACTH and cortisol seen with different diseases involving the adrenal and pituitary glands DiseaseCortisolACTHCushing disease pituitary tumor producing ACTH Increased Increased Adrenal tumor Increased Decreased Ectopic ACTH ACTH made by a tumor outside the pituitary usually in the lung Increased Increased Addison disease underactive or damaged adrenal glands Decreased Increased Hypopituitarism Decreased Decreased or normal An increased ACTH result can mean that a person has Cushing disease Addison disease overactive tumor-forming endocrine glands multiple endocrine neoplasia or ectopic ACTH-producing tumors A decreased ACTH result can be due to an adrenal tumor steroid medication or hypopituitarism It is impossible to reliably distinguish Cushing disease and ectopic ACTH from cortisol and ACTH measurement alone A variety of other tests are often used to assist healthcare practitioners in making this distinction Testing the change in the level of cortisol when certain drugs are given to stimulate or suppress hormone production often helps the healthcare practitioner make the right diagnosis To learn more read the Cortisol article

While ACTH is still used to diagnose adrenal insufficiency Addison disease the ACTH stimulation test is the preferred diagnostic test when available Taking certain medications such as any steroid oral inhaled topical or eye drop may cause abnormal results Megestrol acetate can also cause abnormal results Mifepristone RU486 is a glucocorticoid receptor antagonist and as such likely causes changes to ACTH levels Stress may increase ACTH secretion ACTH has also been used therapeutically as a drug to treat multiple sclerosis and infantile spasms

Cushing disease is caused by a pituitary gland tumor usually benign that over-secretes the hormone ACTH thus overstimulating the adrenal glands cortisol production Cushing syndrome refers to the signs and symptoms associated with excess cortisol in the body regardless of the cause In addition to a pituitary tumor taking steroid hormones often used to treat cancer or autoimmune diseases adrenal gland tumors and ACTH-producing tumors outside the pituitary gland can cause Cushing syndrome

Addison disease is a condition caused by damage or destruction of the adrenal cortex This damage leads to lack of cortisol and other adrenal steroids It is typically felt to be an autoimmune condition

In addition to an excess of ACTH from the pituitary gland it can also come from elsewhere in the body This is known as ectopic production of ACTH which comes from tumors elsewhere in the body usually but not always in the lungs This causes Cushing syndrome and may alert your healthcare practitioner to the presence of a non-cancerous tumor