ACTG

Adrenocorticotropic hormone (ACTH): role, symptoms of blood imbalance and normality

1. The role of ACTH in the body

ACTH (adrenocorticotropic hormone) is a hormone produced by the anterior pituitary gland under the control of the hypothalamus (via corticoliberin, CRH).

Main functions:
✔ Adrenal Stimulation – ACTH causes the adrenal cortex to produce:

Cortisol (a glucocorticoid that regulates metabolism and stress response).
Androgens (precursors of sex hormonesHormones are biologically active substances that are produced by specialized cells or glands (such as endocrine glands) and regulate various physiological processes in the body. They act as chemical signals that are transmitted through the bloodstream to organs and tissues to control and coordinate a wide range of functions, including metabolism, growth and development, reproduction, mood, and more. Examples include insulin, testosterone, estrogen, and adrenaline.).
To a lesser extent – aldosterone (a mineralocorticoid that controls the water-salt balance).

✔ Maintaining circadian rhythms – ACTH levels are maximal in the morning (6-8 hours) and minimal in the evening.

✔ Participation in the stress response – under stress (physical or emotional), ACTH secretion increases dramatically.

2. Symptoms of ACTH deficiency (hypocorticism)

Reasons:

Hypopituitarism (pituitary insufficiency due to a tumor, injury, or ischemia).
Long-term use of glucocorticoids (suppresses the production of ACTH on the feedback principle).
Sheehan’s syndrome (postpartum pituitary necrosis).

Symptoms:

Chronic weakness, fatigue (due to lack of cortisol).
Hypoglycemia (low blood sugar).
Weight loss, lack of appetite.
Hypotension (low blood pressure).
Pallor of the skin (due to a decrease in ACTH and melanocyte-stimulating hormone).

3. Symptoms of excess ACTH (hypercorticism)

Reasons:

Itsenko-Cushing ‘s disease(pituitary adenoma, excessively producing ACTH).
Ectopic production of ACTH (in small cell lung cancer, carcinoids).
Adrenal insufficiency (the adrenal glands do not respond to ACTH – > compensatory growth of ACTH).

Symptoms:

Obesity with fat deposition on the face (‘moon face’), stomach, neck.
Stretch marks (striae) purple color on the skin.
Arterial hypertension (high blood pressure).
Osteoporosis (brittle bones).
Hirsutism and acne (due to excess androgens).
Impaired glucose tolerance (prediabetes).

4. Norms of ACTH in the blood test

ACTH levels fluctuate strongly throughout the day:

Time to submit the analysis	Reference values (pg / ml)
Morning (7: 00-10: 00)	7-63 (maximum level)
Evening (18: 00-22: 00)	< 30 (minimum level)

Important:

The test is taken strictly on an empty stomach, in the morning, at rest (stress distorts the result).
At the same time, cortisol is checked for a comprehensive assessment.

5. When is an ACTH test scheduled?

Suspected Itsenko-Cushing’s disease / syndrome.
Diagnosis of adrenal insufficiency (Addison’s disease).
Evaluation of the hypothalamic-pituitary-adrenal axis.
Control of long-term glucocorticoid therapy.

In case of abnormalities , an endocrinologist’s consultation and additional tests (corticoliberin test, pituitary MRI) are required.