What is ACTH
Adrenocorticotropic hormone (ACTH), also known as corticotropin, is a hormone secreted by the pituitary gland. It is often produced in response to biological stress. It increases production of the stress hormone cortisol when physical or mental stress occurs. ACTH is regulated by corticotropin-releasing hormone (CRH), which is from the hypothalamus.
ACTH stimulates the production of cortisol by the adrenal gland. Cortisol is a hormone that is important for suppressing the immune response, maintaining blood pressure, and regulating protein, glucose, and lipid (fat) metabolism. Normally, when cortisol is low, ACTH levels increase, and when cortisol is high, ACTH levels decrease [R].
ACTH blood tests are used alongside cortisol tests to help diagnose adrenal gland problems and pituitary diseases. These disorders include adrenal and pituitary tumors, Addison disease, Cushing’s syndrome, and Cushing’s disease. ACTH blood tests should be done in the morning [R, R].
Normal Range of ACTH
- 5–27 pg/mL [R]
- 5 to 27 pg/mL (1.1–5.9 pmol/L) for females [R]
- 7 to 50 pg/mL (1.5–11 pmol/L) for males [R]
- Early in the morning are 9 to 52 pg/mL (2 to 11 pmol/L).
- 10-60 pg/mL (2.2 and 13.3 pmol/L) at 8 AM.
- ≥18 Years 6-50 pg/mL (Quest)
Low ACTH Causes
- Hypopituitarism (pituitary insufficiency)
- Tumors in the pituitary gland
- Pituitary surgery or radiotherapy
- Damage/trauma to the pituitary gland
Low ACTH can also be caused by tertiary adrenal insufficiency, which occurs when the hypothalamus gland doesn’t produce enough corticotropin-releasing hormone (CRH), the hormone that causes the release of ACTH [R]. Causes of tertiary adrenal insufficiency include [R]:
- Tumors in the hypothalamus
- Hypothalamus surgery or irradiation for tumors
- Infections of the hypothalamus
- Injury or trauma to the hypothalamus
Some drugs may also cause low ACTH levels:
- Corticosteroids (drugs that act like cortisol), including prednisone (Deltasone, Rayos, Prednisone Intensol), dexamethasone (Ozurdex, DexPak), prednisolone (Omnipred, Pediapred, Pred Mild), methylprednisolone (Medrol), and megestrol acetate (Megace), used to treat inflammatory disorders and diseases [R, R, R]
- Opioids such as methadone and heroin [R, R]
- Nivolumab (Opdivo), anti-cancer drug [R]
- Antipsychotics including olanzapine (Zyprexa) and quetiapine (Seroquel) [R]
- Mirtazapine (Remeron), an antidepressant [R]
Low ACTH Effects
Low ACTH levels may cause:
- Low sodium levels (hyponatremia) [R]
- Low blood bicarbonate [R]
- High calcium levels (hypercalcemia) [R]
- Hypothyroidism [R]
Low ACTH Symptoms
Symptoms of secondary and tertiary adrenal insufficiency and hypopituitarism include:
- Nausea and vomiting [R]
- Fatigue [R]
- Lack of appetite [R]
- Low blood sugar [R]
- Muscle weakness [R]
- Depression [R]
Recommendations to Increase ACTH
We recommend the following lifestyle changes:
- Exercising for at least 1 hour may increase your ACTH levels [R].
Supplements that can increase ACTH:
Having high ACTH levels are associated with a higher risk of:
High ACTH Causes
The most common causes of high ACTH levels include:
Other causes of high ACTH levels include:
- Cushing’s disease [R]
- Addison’s disease, which may be caused by [R]:
- Injuries to the adrenal gland
- Infections (sepsis, HIV, tuberculosis)
- Fungal infections
- Sarcoidosis and amyloidosis
- Inherited conditions (Wolman disease and adrenal leukodystrophy)
- ACTH-producing tumors [R]
Some drugs may also cause increases in ACTH levels:
- Levodopa (used to treat Parkinson’s disease; common brands include Sinemet, Duopa, and Sinemet CR) [R]
- Propranolol (treats high blood pressure, chest pain, and irregular heartbeat; common brands include Hemangeol, Inderal XL, and InnoPran XL) [R]
- Metoclopramide (treats stomach and esophageal problems; a common brand is Reglan) [R]
- Reboxetine (Edronax), an antidepressant [R]
Symptoms of High ACTH
- Nausea and vomiting
- Stomach and back pain
- Poor appetite
Cushing disease is caused by a benign tumor that causes the pituitary gland to produce too much ACTH (R).
- Weight gain
- Delayed wound healing
- Excessive sweating (hyperhidrosis)
- Easy bruising
- Decreased libido
- Male-pattern hair growth in women (hirsutism)
- Irregular menstrual cycle
- Erectile dysfunction
- Fat deposits in the upper body
- Purplish lines on the body
Symptoms of Addison’s disease include [R]:
- Weight loss
- Low blood pressure
- Abnormally fast heart rate
- Patches of dark skin (hyperpigmentation)
Recommendations to Decrease ACTH
Massage therapy also reduces ACTH [R].
Refrain from drinking too many caffeinated beverages [R].
Supplements that can help decrease ACTH:
Benefits of ACTH
Adrenal insufficiency causes severe fatigue, loss of appetite, weight loss, nausea, vomiting, diarrhea, muscle weakness, irritability, and depression (R).
ACTH acts as an anti-inflammatory and decreases inflammatory cytokines (R).
Drawbacks of ACTH
ACTH increases blood pressure in humans [R].
ACTH Genes and SNPs
ACTH levels and function are also determined by variations in the following genes:
If you have a genetics file, you can upload it to SelfDecode to get your results.
People go to their doctor to get their ACTH tested as part of a standard panel. Almost always, the results are not scrutinized, even though we know that you can be healthier and live longer when your results lie within optimal ranges. When I used to go to doctors and tried to discuss my results, they had no clue what these meant from a health perspective. All they cared about was whether they could diagnose me with some disease. This is why we created Lab Test Analyzer, a tool that easily lets you know which lab results you need to be concerned about, and how to bring these within the optimal range.