Adrenocorticotropic Hormone (ACTH), Plasma

CPT: 82024 (per specimen)
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Test Details

Synonyms

  • ACTH
  • Corticotropin

Use

Pituitary function test useful in the differential diagnosis of Cushing syndrome, ectopic ACTH syndrome (eg, carcinoma of lung, islet cell tumors, carcinoid tumors, medullary carcinoma of thyroid), Addison disease, hypopituitarism, and ACTH-producing pituitary tumors (eg, Nelson syndrome)

Limitations

ACTH secretion is pulsatile so multiple specimen collections may be required. Collection in nonsiliconized tubes can result in falsely low results as ACTH adheres to glass.

As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from samples taken from patients who have been treated with monoclonal mouse antibodies or who have received them for diagnostic purposes.3 In rare cases, interference due to extremely high titers of antibodies to streptavidin and ruthenium can occur.3 The test contains additives, which minimize these effects.

Methodology

Electrochemiluminescence immunoassay (ECLIA)

Reference Interval

7.2−63.3 pg/mL (Note: For samples collected between 7 AM and 10 AM)

Additional Information

Adrenocorticotropic hormone (ACTH), or corticotropin, is a peptide hormone consisting of 39 amino acids. It is produced in the anterior pituitary of the brain as part of the precursor molecule pro-opiomelanocortin (POMC). Tissue-specific cleavage results in ACTH and a range of related peptides.1,4

ACTH stimulates formation and secretion of glucocorticoids (especially cortisol) by the adrenal cortex. The glucocorticoid production is regulated by various factors.5-8 After stimulation (eg, by physical effort or by the internal body clock), the hypothalamus secretes CRH (corticotropin-releasing hormone). CRH acts on the pituitary, which in turn synthesizes and secretes ACTH. Finally, ACTH stimulates secretion of the glucocorticoids by the adrenals. High concentrations of glucocorticoids in the blood inhibit secretion of CRH and ACTH via a negative feedback mechanism.

ACTH concentrations show a diurnal variation with high levels in the morning and low levels in the evening; therefore, as with cortisol, it is important to know the collection time of the plasma sample for interpretation of the results.

Plasma ACTH measurements are useful in the differential diagnosis of pituitary Cushing's disease (ACTH hypersecretion), autonomous ACTH-producing pituitary tumors (eg, Nelson's syndrome), hypopituitarism with ACTH deficiency, and ectopic ACTH syndrome.9,10 In addition to cortisol measurements, ACTH determinations can be used together with functional or stimulation tests to diagnose the origin of glucocorticoid overproduction. Similarly, ACTH measurements can be employed to facilitate differential diagnosis of adrenocortical insufficiency (Addison's disease).

ACTH not produced by the pituitary gland is known as ectopic ACTH;11 this is often associated with small cell carcinoma of the lung. In rare cases, ectopic ACTH can be caused by thymic tumors, pancreatic adenocarcinomas, or bronchial carcinoids. These tumors often secrete ACTH precursors (POMC and pro-ACTH).

Specimen Requirements

Specimen

Plasma, frozen

Volume

0.8 mL

Minimum Volume

0.3 mL (Note: This volume does not allow for repeat testing.)

Container

Plastic or siliconized glass lavender-top (EDTA) tube

Collection

ACTH should be drawn between 7 AM and 10 AM.

Collect into iced plastic or siliconized glass lavender-top (EDTA) tube, noting time of collection. After venipuncture, immediately immerse the tubes in an ice bath. Separate plasma from cells by centrifugation within one hour after venipuncture.1,2 Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N° 49482) immediately. Freeze immediately and maintain frozen until tested. Contact LabCorp's supply department for special tubes. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.

Storage Instructions

Freeze immediately.

Stability Requirements

Temperature

Period

Room temperature

Unstable

Refrigerated

Unstable

Frozen

14 days

Freeze/thaw cycles

Stable x1

Causes for Rejection

Thawed specimen; serum or heparinized plasma specimen; specimen collected in nonsiliconized glass tube

Clinical Information

Special Instructions

Instructions for suppression/stimulation tests involving ACTH measurement can be found in the online endocrine appendices ACTH Stimulation and Corticotropin-releasing Hormone Stimulation.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

Footnotes

1. Talbot JA, Kane JW, White A. Analytical and clinical aspects of adrenocorticotrophin determination. Ann Clin Biochem. 2003 Sep; 40(Pt 5):453-471. 14503983
2. Reisch N, Renicke M, Bidlingmaier. Practical stability of adrenocorticotropic hormone depends on time to centrifugation rather than temperature. Clin Chem. 2007 Feb; 53(2):358-359.
3. ACTH on Elecsys 1010/2010 and Modular Analytics E170. [package insert]. 2007-07, V 4. Indianapolis, Ind: Roche Diagnostics; 2007. 2545177
4. Cone RD. Anatomy and regulation of the central melanocortin system. Nat Neurosci. 2005; 8(5):571-578. 15856065
5. Jacobson L. Hypothalamic-pituitary-adrenocortical axis regulation. Endocrinol Metab Clin North Am. 2005; 34(2):271-292. 15850842
6. Arlt W, Stewart PM. Adrenal corticosteroid biosynthesis, metabolism, and action. Endocrinol Metab Clin North Am. 2005; 34(2):293-313. 15850843
7. Lin L, Achermann JC. The adrenal. Horm Res. 2004; 62(Suppl 3):22-29. 15539795
8. Engelmann M, Landgraf R, Wotjak CT. The hypothalamic-neurohypophysial system regulates the hypothalamic-pituitary-adrenal axis under stress: An old concept revisited. Front Neuroendocrinol. 2004; 25(3-5):132-149. 15589266
9. Beauregard C, Dickstein G, Lacroix A. Classic and recent etiologies of Cushing's syndrome: Diagnosis and therapy. Treat Endocrinol. 2002; 1(2):79-94. 15765624
10. Lindsay JR, Nieman LK. Differential diagnosis and imaging in Cushing's syndrome. Endocrinol Metab Clin North Am. 2005; 34(2):403-421. 15850850
11. Oliver RL, Davis JR, White A. Characterization of ACTH-related peptides in ectopic Cushing's syndrome. Pituitary. 2003; 6(3):119-126. 14971736

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
004440 ACTH, Plasma 2141-0 004441 ACTH, Plasma pg/mL 2141-0

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