ACTH stimulation test
To help diagnose Addison's Disease and assess pituitary function
When the doctor suspects that the adrenal gland is not producing enough cortisol or that the pituitary gland is not producing enough adrenocorticotrophic hormone (ACTH)
A blood sample is collected and then a small amount of Synacthen is given as an intramuscular injection. A further blood sample is taken after 30 minutes and sometimes after 60 minutes.
Synacthen is a manufactured drug that acts like adrenocorticotrophic hormone (ACTH) by stimulating the adrenal gland to produce more cortisol. By measuring the rise in cortisol in the blood the doctor can see if the adrenal glands are secreting normal amounts of cortisol.
You will be asked to lie down for this test. A needle or small polystyrene tube (a cannula) with a valve mechanism on the end is put into a vein in your arm. The end is taped to your arm and remains in place during the test. A baseline blood sample is taken through the cannula before the test. A solution containing Synacthen is then injected into the muscle. After 30 minutes a second sample of blood is taken. Some clinics also take a third sample at 60 minutes. Cortisol is measured in the blood samples. The doctor may also ask for ACTH to be measured in the baseline sample.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles under: Coping with Discomfort and Anxiety.
Another article, Follow a sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
The test is used to see if the adrenal glands are producing normal amounts of cortisol. When the adrenal does not produce enough cortisol and aldosterone the patient can feel tired, lethargic, sick and lose weight and may become dangerously ill. Synacthen stimulates the adrenal glands to produce these steroids. If the adrenal glands are not working properly then the rise in cortisol after the injection of synacthen is either low or absent.
The adrenal gland is normally stimulated to work by ACTH, the hormone produced by the pituitary gland that Synacthen mimics. If the pituitary is not working for more than a few weeks the adrenal glands will shrink and not be able to respond to the Synacthen. Therefore the Synacthen test can also be used to assess pituitary function.
When the doctor suspects the adrenal glands are not working properly and that the patient may have Addison’s disease.
When the doctor wants to assess pituitary function e.g. if a pituitary tumour is found on an X-ray or after brain radiotherapy.
A normal rise in cortisol means the adrenal and pituitary glands are working properly and you don’t have Addison’s or pituitary disease. The laboratory and doctors will have established what a normal cortisol rise is. If the rise in cortisol is low or absent it suggests that the patient has Addison’s disease or pituitary ACTH deficiency.
The doctor will probably take more blood for other tests to find out whether it is the adrenal or pituitary gland that is not working properly and why. If your result is very abnormal the doctor will give you steroids to replace those your body is not producing.
ACTH, Cortisol
Condition: Addison's Disease
RCPA Manual - Synacthen stimulation test Netdoctor - Synacthen Patient UK - Synacthen Test
Last Review Date: January 10, 2023