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ACTH: Examination Diagnoses Cushing's Syndrome

ACTH: Examination Diagnoses Cushing's Syndrome

The ACTH test measures the amounts of adrenocorticotrophic hormone in the blood. It is used to check for problems with the pituitary gland and adrenal glands.

The adrenocorticotrophic hormone (ACTH) is responsible for stimulating the production of cortisol. In turn, cortisol is an important steroid hormone for regulating glucose, protein and lipid metabolism. It also acts on suppressing the immune system's response and helps maintain blood pressure.

ACTH is produced by the pituitary gland. Located below the brain in the center of the head, the pituitary gland is part of the endocrine system, a network of glands that works to produce hormones that regulate the body's system.

Normally, ACTH levels increase when cortisol is low and falls when cortisol is high. Conditions that affect the pituitary or adrenal glands can increase or decrease the amount of ACTH and cortisol that the glands produce, interfering with their regulation.


Adrenocorticotrophic hormone dosage, ACTH dosage


Blood ACTH levels are measured to help detect, diagnose, and monitor conditions associated with excessive or deficient production of cortisol in the body. These conditions include:

  • Cushing's syndrome
  • Addison's disease
  • Secondary adrenal insufficiency
  • Hypopituitarism.

The test is also requested when someone has signs or symptoms associated with excess or cortisol deficiency.

Excess cortisol can cause symptoms that include:

  • Obesity, with most of the weight on the trunk of the body on arm and leg debris
  • Rounded face
  • Fragile skin
  • Purple lines on the abdomen
  • Muscle weakness
  • Acne
  • Excess hairs

These symptoms are often accompanied by changes such as high blood pressure, potassium deficiency, and hyperglycemia that may progress to diabetes.

People with low production of cortisol may have symptoms such as:

  • Muscle weakness
  • Fatigue
  • Unintentional weight loss
  • Increased pigmentation of the skin even in areas not exposed to the sun
  • Loss of appetite

The above symptoms are often accompanied by such as low blood pressure, hypoglycaemia, sodium deficiency, high levels of potassium and calcium in the blood.

Finally, the test may be ordered to identify hypopituitarism. Suggestive symptoms include:

  • Loss of appetite
  • Fatigue
  • Irregular menstrual cycle
  • Hypogonadism
  • Decreased sexual desire
  • Nocturia
  • Unintentional weight loss

When Hypopituitarism occurs due to one's, the person may also exhibit symptoms associated with the compression of neighboring nerves and cells. The tumor can affect the nerves that control the vision, causing symptoms like loss of vision for some localized areas or double vision.


Because it is a common blood test, there are no express contraindications to the ACTH dosage. However, the doctor or doctor will tell you whether or not you can take the test.

Pregnant can do?

Women during pregnancy are allowed to take the examination as directed medical, there being no contraindications. However, the results may be altered by the hormonal changes typical of pregnancy.

Examination Preparation

For the ACTH examination, a minimum fasting of eight hours is required before blood collection. It is also important to tell the doctor or doctor what medications you take regularly, including dietary supplements. In some cases, it may be necessary to stop using the medication. However, do not stop taking any medicine without professional authorization.

The examination is preferably done in the morning, since the reference values ​​are usually based on the collection of these hours. Talk to your doctor about the best time to take the ACTH test in your case.

How it is done

In a hospital or laboratory, the ACTH test is performed by a health care professional as follows:

  • With the patient seated, a rubber band is tied around his arm to stop the flow of blood. This causes the veins to become wider, helping the practitioner hit one of them.
  • The professional cleans the arm area to be penetrated by the needle.
  • The needle is inserted into the vein. This procedure can be done more than once until the health care provider hits the vein and is able to remove the blood.
  • Blood collected in the syringe and placed in a tube
  • The elastic is removed and a gauze is placed on the where the health professional inserted the needle, to prevent any bleeding. He or she can put pressure on the bandage to staunch the blood
  • A bandage is placed on the spot.

It is important that the technician or technician write down the time of collection as ACTH levels change during the day .

Examination time

An ACTH examination takes only a few minutes to complete, and may take longer in cases where the health professional has difficulty correcting blood collection.

Post- exam

There are no special recommendations after the examination. The patient can do his / her activities normally. If the blood sample is used for other tests that require fasting, the patient may feed after collection.

Frequency of the test

There is no periodicity for an ACTH test. All of this will depend on the doctor's guidelines and the presence or absence of diseases that must be followed by the test.


The risks involved in performing the ACTH test are extremely rare. At most, there may be a hematoma at the site where blood was withdrawn. In some cases, the vein may become swollen after the blood sample is collected (phlebitis), but this can be reversed by making a compress several times a day.

People who use anticoagulant medications or have coagulation problems may suffer from a bleeding after collection. In these cases, it is important to inform the health professional of the problem prior to collection.


The test results are usually available within one business day. The interpretation of the ACTH exam depends on the reason why it was required. Therefore, it is important to talk to your doctor for any questions.

Normal results

ACTH levels are measured in petagrams (pg) per milliliter of blood (mL). The reference values ​​are between 7 pg / ml and 63 pg / ml.

Abnormal results

ACTH levels above normal may indicate:

  • Addison's disease
  • Congenital adrenal hyperplasia
  • One or more of the endocrine glands are hyperactive or there is a tumor (multiple endocrine neoplasia type I)
  • Cushing's syndrome
  • Rare type of tumor (lung, thyroid or pancreas) that increases ACTH production
  • Physical or emotional stress (caused by recent surgery or trauma that has caused severe pain, for example)

ACTH dosage lower than normal may indicate:

  • Hypopituitarism
  • Tumor of the adrenal gland that produces excess cortisol
  • Glucocorticoid drugs that are suppressing the production of ACTH.
Cushing's diseaseHighHigh
Adrenal gland tumorHighLow
Tumor that increases the production of ACTHHighHigh
Addis' diseaseLowHigh

ACTH test results are best interpreted when ordered in conjunction with cortisol dosing. The table below indicates the common ACTH and cortisol patterns and their indications:

What may affect the test result

The following conditions may change the ACTH test results:

  • Medications affecting the production of cortisol or ACTH
  • Drunkenness
  • Pregnancy
  • Serious injury
  • Physical or emotional stress.

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