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The ACTH test (also called the cosyntropin, tetracosactide, or Synacthen test) is a medical test usually requested and interpreted by endocrinologists to assess the functioning of the adrenal glands' stress response by measuring the adrenal response to adrenocorticotropic hormone (ACTH; corticotropin) or another corticotropic agent such as tetracosactide (cosyntropin, tetracosactrin; Synacthen ...
It is possible to test for heterozygosity by measuring 17OHP elevation after ACTH stimulation. [139] More than 200 disease-causing variants within the CYP21A2 gene have been identified so far that lead to 21-hydroxylase deficiency. [140] Most patients have at least two of these variants present as compound heterozygous. [141] [142] [143]
Urinary free cortisol can also be measured, but are not necessary for diagnosis. [2] To determine the origin of dysfunction, the ACTH stimulation test is the best initial test as it can differentiate between primary and secondary adrenal insufficiency. [2]
A low-dose ACTH stimulation test has been suggested as a sensitive test for secondary adrenal insufficiency diagnosis. [10] When compared to insulin tolerance testing [11] and the high-dose ACTH test, this test allows for a more accurate identification of patients with secondary adrenal insufficiency. [12]
Inefficient cortisol production results in rising levels of ACTH, because cortisol feeds back to inhibit ACTH production, so loss of cortisol results in increased ACTH. [28] This increased ACTH stimulation induces overgrowth (hyperplasia) and overactivity of the steroid-producing cells of the adrenal cortex. The defects causing adrenal ...
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Furthermore, a short test might not adequately assess response to the chronic stress of critical illness. [6] Both random total cortisol levels, total cortisol levels or increment after ACTH stimulation tests, free cortisol levels, or a combination of these have been proposed as diagnostic tests.
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