Why is this test performed? This hormone test is evaluated in different conditions, such as Adrenal insufficiency, in Acromegaly and Cushing Syndrome. In Addison's disease, the level of Adrenocorticotropic hormone (ACTH) is noted more than 1000 pg/ml. In Adrenal carcinoma, Adenoma, and Adrenocortical insufficiency, the level of Adrenocorticotropic hormone (ACTH) decreases. Collection of Sample For the estimation of Adrenocorticotropic hormone (ACTH), patient’s plasma is needed. Blood is collected in a chilled plastic test tube containing EDTA or heparin and blood is placed in cold ice-water. The sample is centrifuged at 4º C, plasma is separated and stored at -20º C immediately within 15 minutes of the blood collection. See: Uses of anticoagulants for hematological investigations Note: For the diagnosis of Cushing Syndrome, the blood sample is collected in between 6 PM to 11 PM. See: Procedures for the collection of blood for hematological investigations Precautions Collect the blood sample in a chilled plastic test tube containing EDTA or heparin. Avoid high carbohydrates diet, take the low-carb diet. Avoid physical activity for 12 hours before the collection of the blood sample. Stop medication such as corticosteroids, 48 hours before the collection of blood sample. An anxious collection of the blood sample may increase the level of Adrenocorticotropic hormone (ACTH). Normal Values 6 to 8 AM: < 80 pg/ml or < 18 pmol/L (SI units)6 to 11 MP: < 50 pg/ml or < 11 pmol/L (SI units)or less than 120 pg/ml According to another references:8 AM: < 120 pg/mL4 to 8 PM: < 85 pg/mLCord blood: 50 to 570 pg/mLNewborn: 10 to 185 pg/mL Table 881.1 ACTH and Cortisol values in various conditions and diseases. Disease ACTH Value Cortisol Value Cushing syndrome Increased/low Increased Adrenal cancer Low Raised Adrenal adenoma Low Raised Ectopic ACTH (Lung cancer) Raised Raised ACTH- producing Pituitary tumor Raised Raised Adrenal gland failure ( Infarction, Haemorrhage) Raised Low Hypopituitarism Low Low Congenital adrenal hyperplasia Raised Low Addison's disease — — Reasons for the increased level of ACTH Cushing syndrome Addison's disease Stress Ectopic ACTH syndrome Reasons for the decreased level of ACTH Secondary adrenal insufficiency Exogenous steroid administration Hypopituitarism Adrenal adenoma or carcinoma The significance of Adrenocorticotropic hormone (ACTH) test for the layman This test is advised in abnormal metabolism of lipids. This test is advised to the patients of Diabetes Mellitus (DM). This test is performed for the diagnosis of Cushing syndrome. This test is advised if there are truncal obesity and thin extremity. Figure 881.1 Example of Truncal Obesity