ACTH stimulation test

ACTH stimulation test
SynonymsSynacthen test
OPS-301 code1-797
MedlinePlus003696
LOINC34541-3, 34542-1

The ACTH test (also called the cosyntropin, tetracosactide, or Synacthen test) is a medical test usually requested and interpreted by endocrinologists to assess the functioning of the adrenal glands' stress response by measuring the adrenal response to adrenocorticotropic hormone (ACTH; corticotropin) or another corticotropic agent such as tetracosactide (cosyntropin, tetracosactrin; Synacthen) or alsactide (Synchrodyn).[1][2] ACTH is a hormone produced in the anterior pituitary gland that stimulates the adrenal glands to release cortisol, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and aldosterone.[3]

During the test, a small amount of synthetic ACTH is injected, and the amount of cortisol (and sometimes aldosterone) that the adrenals produce in response is measured.[4] This test may cause mild side effects in some individuals.[5][6]

This test is used to diagnose or exclude primary and secondary adrenal insufficiency, Addison's disease, and related conditions.[2] In addition to quantifying adrenal insufficiency, the test can distinguish whether the cause is adrenal (low cortisol and aldosterone production) or pituitary (low ACTH production).[1] The insulin tolerance test is recognized as the gold standard assay of adrenal insufficiency, but due to the cumbersome requirement for a two-hour test and the risks of seizures or myocardial infarction, the ACTH stimulation test is commonly used as an easier, safer, though not as accurate, alternative.[7] The test is extremely sensitive (97% at 95% specificity) to primary adrenal insufficiency, but less so to secondary adrenal insufficiency (57–61% at 95% specificity); while secondary adrenal insufficiency may thus be dismissed by some interpreters on the basis of the test, additional testing may be called for if the probability of secondary adrenal insufficiency is particularly high.[1]

Adrenal insufficiency is a potentially life-threatening condition. Treatment should be initiated as soon as the diagnosis is confirmed, or sooner if the patient presents in apparent adrenal crisis.[8]

  1. ^ a b c Dorin RI, Qualls CR, Crapo LM (2003). "Diagnosis of adrenal insufficiency" (PDF). Ann. Intern. Med. 139 (3): 194–204. doi:10.7326/0003-4819-139-3-200308050-00017. PMID 12899587. Archived (PDF) from the original on 2008-10-29. Retrieved 2008-02-18.
  2. ^ a b "ACTH stimulation test: MedlinePlus Medical Encyclopedia". MedlinePlus. Archived from the original on 2016-07-05. Retrieved 2024-06-26.
  3. ^ Hanukoglu A, Fried D, Nakash I, Hanukoglu I (Nov 1995). "Selective increases in adrenal steroidogenic capacity during acute respiratory disease in infants". Eur J Endocrinol. 133 (5): 552–6. doi:10.1530/eje.0.1330552. PMID 7581984. S2CID 44439040.
  4. ^ "ACTH Stimulation Test" (PDF), Test Catalog, Warde Medical Laboratory, archived from the original (PDF) on May 6, 2006
  5. ^ Synacthen Test (PDF), St George's Healthcare, archived from the original (PDF; trifold) on February 20, 2005
  6. ^ Ogbru O. "Cosyntropin: Diagnositic Uses, Side Effects, Dosage". MedicineNet. Archived from the original on 2018-11-06. Retrieved 2024-06-26.
  7. ^ Ferrante E, Morelli V, Giavoli C, Mantovani G, Verrua E, Sala E, Malcmiodi E, Bergamaschi S, Profka E, Cairoli E, Palmieri S, Chiodini I, Lania AG, Spada A, Beck-Peccoz P (2012-10-15). "Is the 250 μg ACTH test a useful tool for the diagnosis of central hypoadrenalism in adult patients with pituitary disorders?". Hormones. 11 (4). Springer Science and Business Media LLC: 428–435. doi:10.14310/horm.2002.1374. ISSN 1109-3099. PMID 23422765.
  8. ^ Evangelia Charmandari, George P., Chrousos, M.D. "ADRENAL INSUFFICIENCY Chapter 13". Archived from the original on 2008-03-02.