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  • Also Known As:
  • ACTH
  • Corticotropin
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At a Glance

Why Get Tested?

In conjunction with cortisol testing, to help diagnose adrenal gland problems and pituitary diseases such as Cushing syndrome, Cushing disease, adrenal insufficiency (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 health care 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 health care practitioner may request that you fast overnight before testing. Blood is typically drawn in the morning, about 8 a.m.

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Testing.com. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Testing.com is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Adrenocorticotropic hormone (ACTH) is a hormone that stimulates the production of cortisol. Cortisol is a steroid hormone made by the adrenal glands that is important for regulating glucose, protein, and lipid metabolism, suppressing the immune system’s response, and helping to maintain blood pressure. This test measures the amount of ACTH in the blood.

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 work together to produce hormones that act on organs, tissues, and other glands to regulate systems throughout the body.

Normally, ACTH levels increase when cortisol is low and fall when cortisol is high. In response to a fall in the blood cortisol level, the hypothalamus produces corticotropin-releasing hormone (CRH). This stimulates the production of ACTH by the pituitary, which in turn stimulates the production of cortisol by the adrenal glands, small organs located at the top of each kidney. To make the appropriate amounts of cortisol, the hypothalamus, pituitary, and adrenal glands must be functioning properly.

Conditions that affect the hypothalamus, pituitary, or adrenal glands can interfere with regulating ACTH and cortisol production, increasing or decreasing how much of the hormones the glands produce. This can cause signs and symptoms associated with an excess or deficiency of cortisol. Conditions that affect ACTH include Cushing disease, adrenal insufficiency (Addison disease), and hypopituitarism. Some tumors found outside of the pituitary in locations such as the lungs can also increase cortisol concentrations by producing ACTH.

How is the sample collected for testing?

A blood sample is drawn by needle from a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

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

Common Questions

How is it used?

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.

When is it ordered?

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.

What does the test result mean?

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.

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 health care 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 health care practitioner make the right diagnosis.

Is there anything else I should know?

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.

What is the difference between Cushing disease and Cushing syndrome?

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.

What is Addison disease?

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.

My doctor told me that my extra ACTH is not produced in my pituitary gland. What is going on?

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 health care practitioner to the presence of a non-cancerous tumor.

View Sources

Sources Used in Current Review

(Revised 2010 April 29). Adrenal hyperfunction (Cushing syndrome) testing. Arup Consult. Available online at https://arupconsult.com/sites/default/files/Adrenal%20Hyperfunction%20Testing%20algorithm.pdf. Accessed October 2016.

Elhomsy, G. (2014 September 5). Adrenocorticotropin (ACTH). Medscape Reference. Available online at http://emedicine.medscape.com/article/2088760-overview#a2. Accessed October 2016.

(Updated 2015 September 28). Addison Disease Workup. Medscape Reference. Available online at http://emedicine.medscape.com/article/116467-overview. Accessed October 2016.

(Updated 2015 October 28) Addison disease. MedlinePlus. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/000378.htm. Accessed October 2016.

(Updated 2015 October 28). Cushing Disease. MedlinePlus. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/000348.htm. Accessed October 2016.

(Updated 2015 October 28) ACTH stimulation test. MedlinePlus. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003696.htm. Accessed October 2016.

(Updated 2015 October 28) ACTH blood test. MedlinePlus. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003695.html. Accessed October 2016.

(Updated 2016 March 16). Multiple endocrine neoplasia (MEN) I. MedlinePlus. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/000398.htm. Accessed October 2016.

(Updated 2016 May). Adrenal insufficiency. Arup Consult. Available online at https://arupconsult.com/content/adrenal-insufficiency. Accessed October 2016.

(2016 February 18). Practical Guidance on Primary Adrenal Insufficiency. American Association for Clinical Chemistry. Available online at https://www.aacc.org/publications/cln/cln-stat/2016/february/18/practical-guidance-on-primary-adrenal-insufficiency. Accessed October 2016.

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