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 hormones).
• 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.

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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).

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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).

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4. Norms of ACTH in the blood test

ACTH levels fluctuate strongly throughout the day:

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.

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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.