Significance of the ACTH test index to assess Cushing's syndrome and Addison's disease

ACTH is a hormone secreted by the pituitary gland that stimulates the adrenal cortex to secrete glucocorticoids. The significance of the ACTH test index is to help evaluate diseases related to the pituitary gland and the adrenal region.

1.1. Definition of ACTH Hormone ACTH is a polypeptide chain consisting of many amino acids, secreted from the anterior pituitary gland under the influence of the hormone CRH. ACTH has the role of stimulating the adrenal gland to produce glucocorticoids, and at the same time inhibiting the pituitary gland to reduce ACTH secretion when the concentration of the hormone cortisol in the blood increases to a certain value. ACTH hormone is secreted most from 6 am to 8 am and least at 6 pm - 23 pm.
1.2. Indication of ACTH test The ACTH test helps to assess Cushing's syndrome with hypothalamic, adrenal or ectopic origin, and at the same time monitor the effectiveness of the treatment process for appropriate changes. In addition, the ACTH test is used to confirm adrenal insufficiency of high or low origin, as well as to probe the diagnosis of the entire adrenal enzyme system.

Subjects who should be tested for ACTH are people with cortisol hormone disorders, manifested by the following symptoms:
Increased cortisol: Fatty face and body; acne-prone, flaky, rough skin; hair, hairs grow densely; hypertension; changes in blood glucose levels and sodium, potassium... Cortisol deficiency (in contrast to increased cortisol): Body fatigue, poor concentration; hair loss; dull, cracked skin; anorexia; reduce blood pressure... 1.3. ACTH test procedure ACTH test is performed on a plasma sample. Specimens are usually obtained in the morning; a second blood sample may be obtained in the evening if clinically suggestive of ACTH hypersecretion. The blood sample is then stored in a plastic tube coated with heparin anticoagulant or EDTA and shipped to the laboratory as quickly as possible.
The ACTH test is also quite simple and can be ordered alone or in combination with a physical exam and some other tests (usually the quantification of the hormone cortisol). Patients should eat a low-carbohydrate diet within 48 hours before blood testing, fast and limit physical activity before 10 am - 12 pm.

In healthy people, the blood ACTH index is stable ranging from 6.0 - 76.0 pg/ml or from 1.3 - 16.7 pmol/L. A sudden increase or decrease in the ACTH index in the blood can be a warning sign that the body is experiencing some medical conditions. Therefore, the significance of the ACTH test is to help detect and diagnose pituitary and adrenal gland diseases, such as adrenal tumors or hypopituitarism. The most common, however, is the ACTH test that helps evaluate Cushing's syndrome and Addison's disease.
2.1. Cushing's syndrome Cushing's syndrome is an endocrine disease that occurs when the function of the adrenal cortex is disrupted, causing a chronic increase in glucocorticoid hormones to an uncontrolled level. This endocrine disease is quite common in clinical practice, mainly in women aged 25-40 years. In children, Cushing's syndrome is also known as adrenal dysgenesis.

Clinical manifestations of Cushing's syndrome are central fat (body fat), round red face, and a fatty tumor at the nape of the neck. Infected women will have thick eyelashes, sideburns, beards, mustaches,... Meanwhile, pseudo-Cushing's syndrome caused by using synthetic corticosteroids has similar clinical manifestations with cortical adrenal tumors, for example. such as muscle weakness, muscle atrophy, rapid fatigue, osteoporosis, purple stretch marks and easy bruising...
To cure Cushing effectively, it is necessary to identify the cause of the disease, from which the doctor will appoint Laparoscopic surgery to remove tumors or medical treatment, avoiding dangerous progression to the patient's life.
2.2. Addison's Disease Addison's disease is also known as Primary Adrenal Failure or Adrenal Failure. This is a disorder in which the adrenal glands are not working properly, leading to insufficient production of the necessary hormones. Symptoms of adrenal insufficiency are usually feeling weak, tired or upset stomach, as well as weight loss, loss of appetite, low blood pressure, depression, and changes in hair and skin....
Two small adrenal glands located on top of the kidneys, responsible for producing the hormones cortisol and aldosterone. The adrenal glands of people with Addison's disease secrete very little cortisol and aldosterone. Without these two hormones, the body will excrete salt and water through the urine, causing blood pressure to drop very low. At the same time, potassium levels will also increase to dangerously fast levels. Currently, medicine has not found an effective way to prevent Addison's disease.

3.1. Normal blood ACTH levels A normal healthy person will have a normal blood ACTH reading that ranges from 6.0 to 76.0 pg/ml. At this time the body is not affected by certain diseases.
3.2. Increased ACTH in the blood Some common causes of increased ACTH levels in the blood are:
Due to stress; Addison's disease ; Primary adrenal insufficiency; Displaced ACTH period; Pituitary epithelial tumor; Cushing's disease is caused by an ACTH-secreting pituitary tumor.

3.3. Decreased ACTH blood levels Common causes of low ACTH blood levels include:
Cushing's syndrome; Hypopituitarism ; Primary adrenal hyperfunction due to benign or malignant tumor; Secondary adrenal dysfunction. Note, ACTH test results can be changed due to a number of factors such as:
Stress; Sleep; Stress; Radioisotopes; Some medications lower ACTH levels.

In summary, the ACTH test helps to evaluate Addison's disease, Cushing's syndrome, and several other pituitary conditions. Early detection, identification and timely treatment of hormone disorders will limit the risk of serious disease progression. This is also the meaning of the ACTH blood test index.
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