ACTH stimulation test
Test of adrenal reserve; Cosyntropin stimulation test; Cortrosyn stimulation test; Synacthen stimulation test; Tetracosactide stimulation testThe ACTH stimulation test measures how well the adrenal glands respond to adrenocorticotropic hormone (ACTH). ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands to release a hormone called cortisol.
ACTH
The ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland at the base...
Read Article Now Book Mark ArticleAdrenal glands
The adrenal glands are two small triangle-shaped glands in the upper abdomen. One gland is located on top of each kidney.
Read Article Now Book Mark ArticleHow the Test is Performed
The test is done the following way:
- Your blood is drawn.
- You then receive a shot (injection) of ACTH, usually into the muscle in your shoulder. The ACTH may be a man-made (synthetic) form.
- After either 30 minutes or 60 minutes, or both, depending on how much ACTH you receive, your blood is drawn again.
- The lab checks the cortisol level in all the blood samples.
You may also have other blood tests, including ACTH, as part of the first blood test. Along with the blood tests, you may also have a urine cortisol test or urine 17-ketosteroids test, which involves collecting the urine over a 24-hour period. Sometimes the test is done to measure a different hormone called 17-hydroxy progesterone.
ACTH
The ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland at the base...
Read Article Now Book Mark ArticleUrine cortisol test
The cortisol urine test measures the level of cortisol in the urine. Cortisol is a glucocorticoid (steroid) hormone produced by the adrenal gland. C...
Read Article Now Book Mark ArticleUrine 17-ketosteroids test
17-ketosteroids are substances that form when the body breaks down male steroid sex hormones called androgens and other hormones released by the adre...
Read Article Now Book Mark Article24-hour period
The urine 24-hour volume test measures the amount of urine produced in a day. The amounts of creatinine, protein, and other chemicals released into ...
Read Article Now Book Mark ArticleHow to Prepare for the Test
You may need to limit activities and eat foods that are high in carbohydrates 12 to 24 hours before the test. You may be asked to fast for 6 hours before the test. Sometimes, no special preparation is needed. You may be asked to temporarily stop taking medicines, such as hydrocortisone, which can interfere with the cortisol blood test.
How the Test will Feel
When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.
The injection into the shoulder may cause moderate pain or stinging.
Some people feel flushed, nervous, or nauseated after the injection of ACTH.
Why the Test is Performed
This test can help determine whether your adrenal and pituitary glands are normal. It is most often used when your health care provider thinks you have an adrenal gland problem, such as Addison disease, or pituitary insufficiency. It is also used to see if your pituitary and adrenal glands have recovered from prolonged use of glucocorticoid medicines, such as prednisone or dexamethasone.
Addison disease
Addison disease is a disorder that causes the adrenal glands to not produce enough hormones.
Read Article Now Book Mark ArticlePituitary insufficiency
Hypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.
Read Article Now Book Mark ArticleNormal Results
An increase in cortisol after stimulation by ACTH is expected. Cortisol level after ACTH stimulation should be higher than 13 to 14 mcg/dL (358 to 386 nmol/L) depending on the type of cortisol assay used and, on the dose of ACTH used.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your provider about the meaning of your specific test results.
What Abnormal Results Mean
This test is helpful in finding out if you have:
-
Acute adrenal crisis (life-threatening condition that occurs when there is not enough cortisol)
Acute adrenal crisis
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands...
Read Article Now Book Mark Article - Addison disease (adrenal glands do not produce enough cortisol)
-
Hypopituitarism (pituitary gland is not producing enough hormones such as ACTH)
Hypopituitarism
Growth hormone deficiency means the pituitary gland does not make enough growth hormone.
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Risks
There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another, and from one side of the body to the other. Taking blood 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
- Multiple punctures to locate veins
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
References
Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.
Torpy DJ, Bancos I, Husebye E. Adrenal insufficiency. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 93.
Review Date: 8/28/2023
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.