The hormone of the anterior pituitary gland in the human body is adrenocorticotropic hormone, also known as ACTH or corticotropin. With its help, mobilization occurs in the human body in cases of stress, the body gets the opportunity to adapt in critical situations, metabolic processes and the functioning of many endocrine glands are maintained normally. The main function of corticotropin is to stimulate the adrenal glands to produce corticosteroid hormones, such as cortisol, sex hormones, such as estrogen and androgen, and catecholamines, such as adrenaline and norepinephrine.
general characteristics
ACTH is a hormone secreted by the anterior pituitary gland under the influence of hypothalamic factors. It is a peptide consisting of 39 amino acid residues. Regulates the production of steroid hormones in the adrenal cortex. The secretion of ACTH outpaces the increase in cortisol levels in the blood. The content of ACTH in the blood changes throughout the day. The maximum concentration is at 6-8 o'clock in the morning, the minimum is about 22 o'clock. With a sharp change in time zones, the daily rhythm of ACTH secretion normalizes within 7 to 10 days. Stress is a strong stimulator of hormone release. ACTH levels are also affected by: the phase of the menstrual cycle, pregnancy, emotional state, pain, fever, physical activity, surgical interventions, etc. The half-life in the blood is 3-8 minutes. In pregnant women, there is an increase in ACTH concentration.
Corticotropin releasing hormone test
In rare cases, ACTH can be produced not only by the pituitary gland, but also by a malignant tumor in any organ. Tests show high levels of ACTH and cortisol. To diagnose the pathology, a test with corticotropin-releasing hormone is prescribed. After it, the ACTH level either increases (indicating Itsenko-Cushing's disease) or remains at the same level (ectopic production syndrome).
To carry out the test, venous blood is taken in the morning on an empty stomach and ACTH is measured. Then 100 mcg of corticotropin-releasing hormone is injected into a vein and blood is drawn after 30, 45 minutes and 1 hour, determining the ACTH level for each time.
The role of ACTH in a woman’s body
Functions of ACTH
- Stimulates the formation of protein and nucleic acids in adrenal cells during prolonged exposure to ACTH. This leads to the growth of the adrenal glands and the proliferation of their cortex. Since the adrenal glands produce a number of important hormones (cortisol, sex hormones progesterone, estrogens, testosterone), their proliferation leads to an increase in the concentration of these substances.
- Directly increases cortisol synthesis with short-term exposure to ACTH. The main role of cortisol is to mobilize the body's resources in a stressful situation. Cortisol provides:
- a rush of blood to the muscles, which allows you to use the “fight or flight” reflex during stress;
- increasing blood glucose levels, which is necessary to improve muscle function;
- has an antiallergic effect;
- has analgesic, anti-inflammatory and anti-stress effects.
Negative properties of cortisol
- immunosuppression – reduces the production of lymphocytes and antibodies;
- decreased muscle mass due to increased protein breakdown;
- slow digestion, decreased intestinal motility;
- deterioration of cognitive abilities - thinking, remembering, understanding, learning, motivation.
- Affects the synthesis of mineralocorticoids - hormones that regulate mineral metabolism (aldosterone, deoxycorticosterone). Aldosterone promotes inflammation and affects kidney function by increasing urinary excretion of potassium and decreasing urinary excretion of sodium. These minerals are responsible for the ability of tissues to retain water, increase the amount of circulating blood, and increase blood pressure. Deoxycorticosterone has similar properties, but less activity.
- Activates androgen precursors – dihydroepiandrostenedione and androstendinone. This leads to an increase in the level of male sex hormones and can be manifested by hair growth on the face and body, acne, ovarian dysfunction and menstrual irregularities.
- Increases the synthesis of cholesterol necessary for the construction of cell walls, nerves, the formation of vitamin D, and the protection of red blood cells from harmful influences.
- Has a melanocyte-stimulating effect. Forces melanocytes to produce more melanin pigment, which determines the color of skin, hair, and iris.
- Affects brain cells. Affects memory, motivation, learning processes. ACTH deficiency causes indifference to the environment, depression, memory impairment, and psychosis.
- Interacts with other peptide hormones – they mutually increase each other’s influence on the body:
- prolactin – is responsible for the growth of the mammary glands, the formation of milk in them, the inhibition of the menstrual cycle, and also reduces the level of estrogen; influences the development of secondary reproductive organs;
- somatotropin - if in excess, children can experience active body growth, and in adults it helps remove fat from fat depots (subcutaneous fat) and their oxidation;
- vasopressin - affects vascular tone and blood pressure, increasing the volume of blood in the vessels.
Regulation of ACTH synthesis
Adrenocorticotropic hormone is produced by a gland at the base of the brain - the pituitary gland, but its synthesis is influenced by the hypothalamus and adrenal glands. These three glands make up the hypothalamic-pituitary-adrenal system, which is responsible for producing and maintaining the required level of hormones.
Serum ACTH levels are regulated through feedback. Schematically, this mechanism looks like this:
- The hypothalamus analyzes the level of adrenal hormones - corticosteroids.
- The hypothalamus enhances the work of the pituitary gland and the synthesis of ACTH with the help of the hormone corticoliberin.
- ACTH acts on receptors located on the membrane of adrenal cortex cells, activating the synthesis of corticosteroids.
- High levels of corticosteroid hormones are sensed by the hypothalamus and suppress the production of ACTH in the pituitary gland.
Failure of this system leads to hormonal imbalance, which is expressed in various diseases.
4. Risks of analysis and what can interfere with the test?
Risks of ACTH testing
If you take a blood test for ACTH, then possible risks may only be associated with taking blood from a vein. In particular, the appearance of bruises at the site of blood sampling and inflammation of the vein (phlebitis). Warm compresses several times a day will relieve phlebitis. If you are taking blood thinning medications, you may bleed at the puncture site.
What can interfere with the test?
Reasons why you may not be able to take a corticotropin test include:
- Taking corticosteroid drugs, estrogens, spironolactone. Also, the test results can be affected by amphetamines and insulin, after taking which the level of cortisol is increased.
- Alcohol or drug intoxication.
- Pregnancy or menstruation in women.
- Physical or emotional stress.
3.How to prepare and how is the analysis carried out?
How to prepare for an ACTH test?
You should not eat, drink, stress, or exercise for 10 to 12 hours before your blood draw.
If the doctor wants to measure the peak level of corticotropin in the blood, then the tests will have to be taken in the morning; if the doctor wants to find out the lowest level, then in the evening.
How is ACTH analysis performed?
An ACTH test is performed after taking blood from a vein. Blood sampling from a vein is carried out according to a standard procedure.
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ACTH is low
Insufficient production of the hormone is associated with the following processes:
- secondary hypocortisolism. If the functioning of the pituitary gland is disrupted (insufficient production of ACTH), atrophy of the adrenal cortex occurs (lack of cortisol synthesis). Functional failure of other glands of the endocrine system may also occur;
- Itsenko-Cushing syndrome. The level of adrenocorticotropic hormone falls in the presence of a malignant tumor in the adrenal glands. It differs from Cushing's disease in that there is excessive production of cortisol and, as a result, a reduction in the production of ACTH by the pituitary gland;
- benign formations in the adrenal glands. The tumors in this case perform the function of the organ and produce additional cortisol, which reduces ACTH levels;
- taking medications from the glucocorticoid group, cryptoheptadine.
ACTH is elevated
Pathology is indicated by a 1.5-fold increase in hormone levels:
- Itsenko-Cushing's disease. It occurs against the background of various pathologies (the most common is pituitary adenoma). Increased iron volume produces more hormone, which means it stimulates excess cortisol production - ACTH increases up to 2 times;
- Addison's disease (cortisol deficiency), as well as congenital adrenal hyperplasia. In these pathologies, the adrenal cortex does not produce cortisol, shifting the function to the pituitary gland. In this regard, the level of ACTH rises sharply; — 2-2.5 times (> 1000 pg/ml);
- paraneoplastic syndrome. It is a consequence of the reaction of the pituitary gland to an oncological formation in any organ;
- Nelson's syndrome. Develops in patients with Cushing's disease, in the presence of a pituitary tumor, after amputation of the adrenal glands. The patient experiences secondary adrenal insufficiency and ACTH levels increase;
- syndrome of ectopic production of adrenocorticotropic hormone - 1.5 times the norm. In rare cases, ACTH can be produced not only by the pituitary gland, but also by a malignant tumor in any organ. Tests show high levels of ACTH and cortisol. To diagnose the pathology, a test with corticotropin-releasing hormone is prescribed. After it, the ACTH level either increases (indicates Itsenko-Cushing's disease) or remains at the level (ectopic production syndrome);
- taking medications. Lithium-based drugs, insulin, ethanol, calcium gluconate, amphetamines, aminoglutethimide, levodopa, metoclopramide, metyrapone, pyrogens, vasopressin can artificially increase ACTH levels.
The role of ACTH in a woman’s body
Functions of ACTH
- Stimulates the formation of protein and nucleic acids in adrenal cells during prolonged exposure to ACTH. This leads to the growth of the adrenal glands and the proliferation of their cortex. Since the adrenal glands produce a number of important hormones (cortisol, sex hormones progesterone, estrogens, testosterone), their proliferation leads to an increase in the concentration of these substances.
- Directly increases cortisol synthesis with short-term exposure to ACTH. The main role of cortisol is to mobilize the body's resources in a stressful situation. Cortisol provides:
- a rush of blood to the muscles, which allows you to use the “fight or flight” reflex during stress;
- increasing blood glucose levels, which is necessary to improve muscle function;
- has an antiallergic effect;
- has analgesic, anti-inflammatory and anti-stress effects.
Negative properties of cortisol
- immunosuppression – reduces the production of lymphocytes and antibodies;
- decreased muscle mass due to increased protein breakdown;
- slow digestion, decreased intestinal motility;
- deterioration of cognitive abilities - thinking, remembering, understanding, learning, motivation.
- Affects the synthesis of mineralocorticoids - hormones that regulate mineral metabolism (aldosterone, deoxycorticosterone). Aldosterone promotes inflammation and affects kidney function by increasing urinary excretion of potassium and decreasing urinary excretion of sodium. These minerals are responsible for the ability of tissues to retain water, increase the amount of circulating blood, and increase blood pressure. Deoxycorticosterone has similar properties, but less activity.
- Activates androgen precursors – dihydroepiandrostenedione and androstendinone. This leads to an increase in the level of male sex hormones and can be manifested by hair growth on the face and body, acne, ovarian dysfunction and menstrual irregularities.
- Increases the synthesis of cholesterol necessary for the construction of cell walls, nerves, the formation of vitamin D, and the protection of red blood cells from harmful influences.
- Has a melanocyte-stimulating effect. Forces melanocytes to produce more melanin pigment, which determines the color of skin, hair, and iris.
- Affects brain cells. Affects memory, motivation, learning processes. ACTH deficiency causes indifference to the environment, depression, memory impairment, and psychosis.
- Interacts with other peptide hormones – they mutually increase each other’s influence on the body:
- prolactin – is responsible for the growth of the mammary glands, the formation of milk in them, the inhibition of the menstrual cycle, and also reduces the level of estrogen; influences the development of secondary reproductive organs;
- somatotropin - if in excess, children can experience active body growth, and in adults it helps remove fat from fat depots (subcutaneous fat) and their oxidation;
- vasopressin - affects vascular tone and blood pressure, increasing the volume of blood in the vessels.
Regulation of ACTH synthesis
feedback
- The hypothalamus analyzes the level of adrenal hormones - corticosteroids.
- The hypothalamus enhances the work of the pituitary gland and the synthesis of ACTH with the help of the hormone corticoliberin.
- ACTH acts on receptors located on the membrane of adrenal cortex cells, activating the synthesis of corticosteroids.
- High levels of corticosteroid hormones are sensed by the hypothalamus and suppress the production of ACTH in the pituitary gland.
Clinic Family Doctor on Usacheva
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