Newcastle Laboratories

ACTH, plasma

Clinical Background:

Adrenocorticotropic hormone (ACTH), the primary stimulus for adrenal cortisol production, is synthesized by the pituitary in response to corticotropin-releasing hormone (CRH), which is released by ...

Adrenocorticotropic hormone (ACTH), the primary stimulus for adrenal cortisol production, is synthesized by the pituitary in response to corticotropin-releasing hormone (CRH), which is released by the hypothalamus. Plasma ACTH and cortisol secretion displays a strong circadian variation with an early morning peak and late-night nadir.
Measurement of ACTH may be useful in the differential diagnosis of hypercortisolism (e.g. Cushing’s disease, ectopic ACTH production, adrenal cortisol producing tumours) and hypocortisolism (e.g. primary adrenal insufficiency, secondary adrenal insufficiency, congenital adrenal hyperplasia). ACTH may be measured on single (usually timed) specimens or as part of a dynamic function test such as the CRH test or inferior petrosal sinus sampling (IPSS).

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Test Details

  • Discipline:

    Biochemistry

    Biochemistry

  • Specimen Container Adult:

    Plasma-EDTA

    Plasma-EDTA

  • Specimen Container Paediatric:

    Plasma-EDTA

    Plasma-EDTA

  • Minimum Volume Adult:

    2 mL blood

    2 mL blood

  • Minimum Volume Paediatric:

    1 mL blood

    1 mL blood

  • Special Requirement:

    Send to lab on ice, ASAP

    Send to lab on ice, ASAP

  • Sample Stability:

    Unseparated: 30 minutes (take on ice and separate ASAP)
    Separated: 2 month at -20°C

    Unseparated: 30 minutes (take on ice and separate ASAP)
    Separated: 2 month at -20°C

  • Transport Requirements:

    Frozen

     

    Frozen

     

  • Interpretation:

    In hypocortisolism, an elevated adrenocorticotropic hormone (ACTH) suggests primary adrenal insufficiency, whereas a value that is not appropriately elevated is consistent with secondary adrenal in...

    In hypocortisolism, an elevated adrenocorticotropic hormone (ACTH) suggests primary adrenal insufficiency, whereas a value that is not appropriately elevated is consistent with secondary adrenal insufficiency (pituitary/hypothalamic). In hypercortisolism (Cushing syndrome), a suppressed ACTH is consistent with a cortisol-producing adrenal adenoma or carcinoma, primary adrenal micronodular hyperplasia, or exogenous corticosteroid use. Normal or elevated ACTH in a patient with Cushing syndrome suggests ACTH-dependent Cushing syndrome. This can be due to an ACTH-producing pituitary adenoma or ectopic ACTH production. Further testing such as dexamethasone suppression, CRH stimulation testing, IPSS and imaging studies are usually necessary to determine the source of ACTH production.

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  • Reference Ranges:

    0 - 46 ng/L

    0 - 46 ng/L

  • Factors Affecting Result:

    Gross haemolysis, icterus or lipaemia may interfere.
    Heterophilic antibodies can interfere with immunoassays.

    Gross haemolysis, icterus or lipaemia may interfere.
    Heterophilic antibodies can interfere with immunoassays.

  • Routine Contact Name:

    Duty Biochemist

  • Routine Telephone:

    Freeman: 0191 244 8889

    RVI: 0191 282 9719

    Freeman: 0191 244 8889

    RVI: 0191 282 9719

  • Routine Email:

    - For external users: TNU-Tr.duty.biochemist@nhs.net

    - For Trust users: DutyBiochemist@nuth.nhs.uk

  • Specialist Test:

    Yes

    Yes

  • Specialist Contact Name:

    Endocrine Lab

    Endocrine Lab

  • Specialist Telephone:

    0191 282 4025

    0191 282 4025

Availability:

Available during full access hours
Assayed weekly
Site of analysis: RVI

Turn Around:

Within 2 weeks

Send To:

Department of Blood Sciences – RVI

Level 3
Leazes Wing
Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne
NE1 4LP

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