ACTH

Alternative names
Serum adrenocorticotropic hormone; Adrenocorticotrophic hormone; Highly-sensitive ACTH

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

How the test is performed
Adult or child:
Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to fill with blood. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. The tourniquet is then removed to restore circulation. After blood has been collected the needle is removed, and the puncture site is covered to stop any bleeding.

Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any bleeding.

The levels of ACTH vary with the body’s circadian rhythms (the pattern of physiologic changes that occurs on a 24-hour cycle). 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 the person to:

     
  • Discontinue the use of steroid drugs  
  • Be at the laboratory or office where the blood is being drawn by or before 8 a.m., or when instructed

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

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 indicate the causes of hormone irregularities. ACTH is a protein hormone secreted from the anterior pituitary gland. The main function of ACTH is the regulation of the steroid hormone cortisol, which is secreted by the adrenal cortex.

Normal Values
Values 9 to 52 pg/ml are normal. Normal value ranges may vary slightly among different laboratories.

Note: pg/ml = picograms per milliliter

What abnormal results mean
Greater-than-normal levels of ACTH may be from:

     
  • Addison’s disease (because of deficient production by the adrenal gland)  
  • Adrenoleukodystrophy (very rare)  
  • Cushing’s disease  
  • Ectopic tumor producing ACTH  
  • Nelson’s syndrome (very rare)

Lower-than-normal levels of ACTH may be from:

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

Additional conditions under which the test may be performed:

     
  • Hypopituitarism  
  • Multiple endocrine neoplasia (MEN) I

What the risks are

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

Special considerations
Special handling of the blood sample is required.

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.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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