ACTH

Answer 1

Definition

An ACTH test measures ACTH, a hormone released from the anterior pituitary gland in the brain.

Alternative Names

Serum adrenocorticotropic hormone; Adrenocorticotropic hormone; Highly-sensitive ACTH

How the test is performed

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

The levels of ACTH change with the body's natural 24-hour cycle of processes (circadian rhythms). This test is most accurate if it is performed early in the morning.

How to prepare for the test

The health care provider may advise you to stop taking steroid drugs. You may need to be at the laboratory or office where the blood is being drawn by or before 8 a.m.

How the test will feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test can help find the causes of hormone problems.

The main function of ACTH is to regulate the steroid hormone cortisol, which is released by the adrenal cortex.

Normal Values

Normal values: 9 - 52 pg/mL

Note: pg/mL = picograms per milliliter

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Higher than normal levels of ACTH may be due to:

• Addison's disease
• Adrenoleukodystrophy (very rare)
• Congenital adrenal hyperplasia
• Cushing's disease
• Ectopic tumor producing ACTH
• Nelson's syndrome (very rare)

Lower than normal levels of ACTH may be due to:

• Cushing syndrome related to adrenal tumor
• Exogenous Cushing syndrome
• Pituitary insufficiency

Other conditions under which the test may be performed:

• Hypopituitarism
• Multiple endocrine neoplasia (MEN) I

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Special considerations

Special handling of the blood sample is required.

References

Stewart PM. The adrenal cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 14.

Melmed S, Kleinberg D. Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 8.

Answer 2

Definition

An ACTH test measures ACTH, a hormone released from the anterior pituitary gland in the brain.

Alternative Names

Serum adrenocorticotropic hormone; Adrenocorticotropic hormone; Highly-sensitive ACTH

How the test is performed

A blood sample is needed. For information on how this is done, see: Venipuncture

ACTH levels change with the body's natural 24-hour cycle of processes (circadian rhythms). This test is most accurate if it is performed early in the morning.

How to prepare for the test

The health care provider may advise you to stop taking steroid drugs. You may need to be at the laboratory or office where the blood is being drawn by or before 8 a.m.

How the test will feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test can help find the causes of hormone problems.

The main function of ACTH is to regulate the steroid hormone cortisol, which is released by the adrenal cortex.

Normal Values

Normal values: 9 - 52 pg/mL

Note: pg/mL = picograms per milliliter

The examples above are common measurements for results for these tests. Some laboratories use different measurements or may test different specimens. Normal value ranges may vary slightly among different labs. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Higher-than-normal levels of ACTH may be present with:

• Addison's disease, when the adrenal glands do not produce enough cortisol
• Congenital adrenal hyperplasia
• When the pituitary makes too much of the hormone ACTH (called Cushing's disease), which may be caused by excess growth of the pituitary gland, or tumors of the pituitary gland or elsewhere in the body (such as the pancreas, lung, and thyroid)

Lower-than-normal levels of ACTH may be seen with:

• Pituitary gland that is not producing enough hormones, such as ACTH
• Tumor of the adrenal gland that produces too much cortisol
• Tumor elsewhere in the body that produces cortisol

Other conditions under which the test may be performed:

• Hypopituitarism
• Multiple endocrine neoplasia (MEN) I

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Special considerations

Special handling of the blood sample is required.

References

Stewart PM, Krone NP. The adrenal cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 15.

Melmed S, Kleinberg D. Pituitary masses and tumors. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 9.

Reviewed By

Review Date: 12/11/2011

Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.