ACTH stimulates the release of cortisol, a stress hormone. Learn what causes ACTH to rise & fall, plus how you can normalize yours naturally.

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 the 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 [1].

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 [2, 3].

Normal Range of ACTH

  • 5 – 27 pg/mL [4]
  • 5 to 27 pg/mL (1.1 – 5.9 pmol/L) for females [5]
  • 7 to 50 pg/mL (1.5 – 11 pmol/L) for males [5]
  • 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)



The most common cause of low ACTH is high cortisol levels [6, 7].

Another cause of low ACTH is secondary adrenal insufficiency, which occurs when the pituitary gland cannot produce enough ACTH [8]. Causes of secondary adrenal insufficiency include [9, 10, 11]:

  • Hypopituitarism (pituitary insufficiency)
  • Tumors in the pituitary gland
  • Pituitary surgery or radiotherapy
  • Damage/trauma to the pituitary gland
  • Sepsis

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 [12]. Causes of tertiary adrenal insufficiency include [12]:

  • 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 [13, 8, 14]
  • Opioids such as methadone and heroin [15, 16]
  • Nivolumab (Opdivo), anti-cancer drug [17]
  • Antipsychotics including olanzapine (Zyprexa) and quetiapine (Seroquel) [18]
  • Mirtazapine (Remeron), an antidepressant [19]

Low ACTH Effects

Low ACTH levels may cause:

  • Low sodium levels (hyponatremia) [20]
  • Low blood bicarbonate [21]
  • High calcium levels (hypercalcemia) [16]
  • Hypothyroidism [22]

Low ACTH Symptoms

Symptoms of secondary and tertiary adrenal insufficiency and hypopituitarism include:

  • Nausea and vomiting [23]
  • Fatigue [23]
  • Lack of appetite [20]
  • Low blood sugar [24]
  • Muscle weakness [23]
  • Depression [20]

Recommendations to Increase ACTH

We recommend the following lifestyle changes:

  • Exercising for at least 1 hour may increase your ACTH levels [25].

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:

  • Stress [31]
  • Caffeine [26]

Other causes of high ACTH levels include:

  • Cushing’s disease [32]
  • Addison’s disease, which may be caused by [33]:
    • Injuries to the adrenal gland
    • Infections (sepsis, HIV, tuberculosis)
    • Fungal infections
    • Sarcoidosis and amyloidosis
    • Inherited conditions (Wolman disease and adrenal leukodystrophy)
  • ACTH-producing tumors [34]

Some drugs may also cause increases in ACTH levels:

  • Levodopa (used to treat Parkinson’s disease; common brands include Sinemet, Duopa, and Sinemet CR) [35]
  • Propranolol (treats high blood pressure, chest pain, and irregular heartbeat; common brands include Hemangeol, Inderal XL, and InnoPran XL) [36]
  • Metoclopramide (treats stomach and esophageal problems; a common brand is Reglan) [37]
  • Reboxetine (Edronax), an antidepressant [38]

Symptoms of High ACTH

Non-specific symptoms of high ACTH levels include [32, 33]:

  • Fatigue
  • Weakness
  • Depression
  • Nausea and vomiting
  • Dizziness
  • Stomach and back pain
  • Poor appetite

Symptoms of Cushing’s disease include [32, 39]:

Cushing disease is caused by a benign tumor that causes the pituitary gland to produce too much ACTH [40].

  • Weight gain
  • Delayed wound healing
  • Excessive sweating (hyperhidrosis)
  • Easy bruising
  • Decreased libido
  • Fatigue
  • Swelling
  • 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 [33]:

  • Weight loss
  • Low blood pressure
  • Abnormally fast heart rate
  • Patches of dark skin (hyperpigmentation)

Recommendations to Decrease ACTH

Try to reduce your stress levels, as stress in both physical and mental form can increase ACTH. Relaxing, listening to music, and aromatherapy can help reduce stress [31, 41].

Mindfulness meditation (cultivating awareness to whatever is happening in the present moment) and practicing yoga can help reduce ACTH levels [42, 43].

Massage therapy also reduces ACTH [44].

Aromatherapy with chamomile oil may help prevent stress-induced increases in ACTH levels [45].

Refrain from drinking too many caffeinated beverages [26].

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 [51].

ACTH acts as an anti-inflammatory and decreases inflammatory cytokines [52].

ACTH can help bone-forming cells by increasing VEGF [53].

Drawbacks of ACTH

ACTH may contribute to heart disease, atherosclerosis, and stroke [52, 54].

ACTH increases blood pressure in humans [55].

ACTH acts on the Serotonin pathway to increase anxiety [56].

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.

Irregular ACTH Levels?

LabTestAnalyzer helps you make sense of your lab results. It informs you which labs are not in the optimal range and gives you guidance about how to get them to optimal. It also allows you to track your labs over time. No need to do thousands of hours of research on what to make of your lab tests.

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