What is the treatment for ACTH?

URL of this page: //medlineplus.gov/lab-tests/adrenocorticotropic-hormone-acth/

This test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone made by the pituitary gland, a small gland at the base of the brain. ACTH controls the production of another hormone called cortisol. Cortisol is made by the adrenal glands, two small glands located above the kidneys. Cortisol plays an important role in helping you to:

  • Respond to stress
  • Fight infection
  • Regulate blood sugar
  • Maintain blood pressure
  • Regulate metabolism, the process of how your body uses food and energy

Too much or too little cortisol can cause serious health problems.

Other names: Adrenocorticotropic hormone blood test, corticotropin

An ACTH test is often done along with a cortisol test to diagnose disorders of the pituitary or adrenal glands. These include:

  • Cushing's syndrome, a disorder in which the adrenal gland makes too much cortisol. It may be caused by a tumor in the pituitary gland or the use of steroid medicines. Steroids are used to treat inflammation, but can have side effects that effect cortisol levels.
  • Cushing's disease, a form of Cushing's syndrome. Cushing's disease is usually caused by a noncancerous tumor of the pituitary gland. The tumor makes too much ACTH. This causes the adrenal glands to make too much cortisol.
  • Addison disease, a condition in which the adrenal gland doesn't make enough cortisol.
  • Hypopituitarism, a disorder in which the pituitary gland does not make enough of some or all of its hormones.

You may need this test if you have symptoms of too much or too little cortisol.

Symptoms of too much cortisol include:

  • Weight gain
  • Buildup of fat in the shoulders
  • Pink or purple stretch marks (lines) on the abdomen, thighs, and/or breasts
  • Skin that bruises easily
  • Increased body hair
  • Muscle weakness
  • Fatigue
  • Acne

Symptoms of too little cortisol include:

You may also need this test if you have symptoms of hypopituitarism. Symptoms will vary depending on the severity of the disease, but may include the following:

  • Loss of appetite
  • Irregular menstrual periods and infertility in women
  • Loss of body and facial hair in men
  • Lower sex drive in men and women
  • Sensitivity to cold
  • Urinating more often than usual
  • Fatigue

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

You may need to fast (not eat or drink) overnight before testing. Tests are usually done early in the morning because cortisol levels change throughout the day.

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

Results of an ACTH test are often compared with the results of cortisol tests and may show one of the following:

  • High ACTH and high cortisol levels: This may mean Cushing's disease.
  • Low ACTH and high cortisol levels: This may mean Cushing's syndrome or a tumor of the adrenal gland.
  • High ACTH and low cortisol levels: This may mean Addison disease.
  • Low ACTH and low cortisol levels. This may mean hypopituitarism.

If you have questions about your results, talk to your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

A test called an ACTH stimulation test is sometimes done instead of an ACTH test to diagnose Addison disease and hypopituitarism. An ACTH stimulation test is a blood test that measures cortisol levels before and after you've received an injection of ACTH.

Learn how to cite this page

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Berkow R, ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:956-58.

Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:104-05.

Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co.; 1996:1215-16

Wilson JD, Foster DW, eds. Textbook of Endocrinology. 8th ed. Philadelphia, PA: W.B. Saunders Company; 1992:249.

JOURNAL ARTICLES
Agha A, Rogers B, Sherlock M, et al. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab. 2004;89:4929-36.

Chikada N, Imaki T, Hotta M, et al. An assessment of bone mineral density in patients withAddison’s disease; isolated ACTH deficiency treated with glucocorticoid. Endocr J.2004;51:355-60.

Agha A, Liew A, Finucane F, et al. Conventional glucocorticoid replacement overtreats adult hypopituitary patients with partial ACTH deficiency. Clin Endocrinol (Oxf). 2004;60:688-93.

Selva KA, LaFranchi SH, Boston B. A novel presentation of familial gluco-corticoid deficiency (FGD) and current literature review. J Pediatr Endocrinol Metab. 2004;17:85-92.

Hiroi N, Ichijo T, Tsuchida Y, et al. A trial of intranasal ACTH(1-24) administration to a patient with isolated ACTH deficiency. Med Sci Monit. 2004;10:CS9-13.

Connery LE, Coursin DB. Assessment and therapy of selected endocrine disorders. Anesthesiol Clin North America. 2004;22:93-123.

Gonc EN, Kandemir N, Kinik ST. Significance of low-dose and standard-dose ACTH Tests compared to overnight metyrapone test in the diagnosis of adrenal insufficiency in childhood. Horm Res. 2003;60:191-97.

Joffe RT, Brasch JS, MacQueen GM. Psychiatric aspects of endocrine disorders in women. Psychiatr Clin North America. 2003;26:683-91.

Packham EA, Brook JD. T-box genes in human disorders. Hum Mol Genet. 2003;12 Spec No 1:R37-44.

Mody S, Brown MR, Parks JS. The spectrum of hypopituitarism caused by PROP1 mutations. Best Pract Res Clin Endocrinol Metab. 2002;16:421-31.

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INTERNET
Online Mendelian Inheritance in Man (OMIM). The Johns Hopkins University. ACTH Deficiency, Isolated; IAD. Entry No: 201400. Last Edited September 23, 2011. Available at: //omim.org/entry/201400. Accessed January 27, 2017.

What is an ACTH test?

Adrenocorticotropic hormone (ACTH) is a hormone produced in the anterior, or front, pituitary gland in the brain. The function of ACTH is to regulate levels of the steroid hormone cortisol, which released from the adrenal gland.

ACTH is also known as:

  • adrenocorticotropic hormone
  • serum adrenocorticotropic hormone
  • highly-sensitive ACTH
  • corticotropin
  • cosyntropin, which is a drug form of ACTH

An ACTH test measures the levels of both ACTH and cortisol in the blood and helps your doctor detect diseases that are associated with too much or too little cortisol in the body. Possible causes of these diseases include:

Your doctor may advise you not to take any steroid drugs before your test. These can affect the accuracy of the results.

The test is usually done first thing in the morning. ACTH levels are highest when you’ve just woken up. Your doctor will likely schedule your test for very early in the morning.

ACTH levels are tested using a blood sample. A blood sample is taken by drawing blood from a vein, usually from the inside of the elbow. Giving a blood sample involves the following steps:

  1. A healthcare provider first cleans the site with an antiseptic to kill germs.
  2. Then, they’ll wrap an elastic band around your arm. This causes the vein to swell with blood.
  3. They’ll gently insert a needle syringe into your vein and collect your blood in the syringe tube.
  4. When the tube is full, the needle is removed. The elastic band is then removed, and the puncture site is covered with sterile gauze to stop the bleeding.

Normal values of ACTH are 9 to 52 picograms per milliliter. Normal value ranges may vary slightly depending on the laboratory. Your doctor will explain your test results to you.

A high level of ACTH may be a sign of:

A low level of ACTH may be a sign of:

  • adrenal tumor
  • exogenous Cushing’s syndrome
  • hypopituitarism

Taking steroid medications can cause low levels of ACTH, so be sure to tell your doctor if you are on any steroids.

Blood tests are normally well-tolerated. Some people have smaller or larger veins, which may make taking a blood sample more difficult. However, risks associated with blood tests like the ACTH hormone test are rare.

Uncommon risks of having blood drawn include:

  • excessive bleeding
  • lightheadedness or fainting
  • hematoma, or blood pooling under the skin
  • infection at the site

Diagnosing ACTH diseases can be highly complex. Your doctor may need to order more laboratory tests and perform a physical examination before they can make a diagnosis.

For ACTH secreting tumors, surgery is usually indicated. Sometimes, drugs such as cabergoline can be used to normalize cortisol levels. Hypercortisolism due to adrenal tumors usually requires surgery as well.

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