Adrenocorticotropic Hormone (ACTH) Stimulation Test

The Adrenocorticotropic hormone (ACTH) stimulation test is a medical procedure used to assess the functioning of the adrenal glands and the pituitary gland. ACTH is a hormone produced by the pituitary gland that stimulates the adrenal glands to produce cortisol, a vital hormone for various bodily functions.

Purpose

The purpose of the ACTH stimulation test is to:

• Evaluate the adrenal glands' ability to produce cortisol in response to ACTH stimulation
• Diagnose and differentiate between primary and secondary adrenal insufficiency
• Assess the pituitary gland's ability to produce ACTH

Procedure

The procedure typically involves the following steps:

1. A blood sample is taken to measure the baseline cortisol level
2. ACTH (usually synthetic ACTH, also known as cosyntropin) is administered intravenously or intramuscularly
3. Blood samples are taken at specified intervals (usually 30 and 60 minutes) after ACTH administration to measure the cortisol response
4. In some cases, additional blood samples may be taken to measure other hormones, such as aldosterone or 17-hydroxyprogesterone

Interpretation of Results

The results of the ACTH stimulation test are interpreted based on the cortisol response:

• A normal response is indicated by a significant increase in cortisol levels after ACTH administration
• A subnormal response may indicate primary or secondary adrenal insufficiency, or other disorders affecting the adrenal glands or pituitary gland
• No response or a minimal response may indicate severe adrenal insufficiency or Addison's disease

Precautions and Contraindications

Certain precautions and contraindications should be considered:

• Pregnant women should only undergo the test if absolutely necessary, as ACTH may stimulate fetal adrenal gland activity
• Patients with a history of allergic reactions to ACTH or other medications should be closely monitored during the test
• Patients with certain medical conditions, such as Cushing's syndrome or hyperthyroidism, may require special consideration and monitoring during the test

Risks and Side Effects

Possible risks and side effects of the ACTH stimulation test include:

• Allergic reactions to ACTH or other medications used during the test
• Pain, redness, or swelling at the injection site
• Dizziness or lightheadedness due to the injection or blood sampling
• In rare cases, anaphylaxis or other severe allergic reactions may occur