A blood sample is needed.

Your health care provider will likely ask you to have the test done early in the morning. This is important because cortisol level varies throughout the day.

You may also be told to stop taking medicines that can affect the test results. These medicines include glucocorticoids such as prednisone, hydrocortisone, or dexamethasone. Do not stop these medicines unless instructed by your provider.

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.

The main function of ACTH is to regulate the glucocorticoid (steroid) hormone cortisol. Cortisol is released by the adrenal gland. It regulates blood pressure, blood sugar, the immune system, and the response to stress.

This test can help find the causes of certain hormone problems.

Normal values for a blood sample taken early in the morning are 9 to 52 pg/mL (2 to 11 pmol/L).

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your provider about the meaning of your specific test results.

A higher-than-normal level of ACTH may indicate:

• Adrenal glands not producing enough cortisol (Addison disease)
• Adrenal glands not producing enough hormones (congenital adrenal hyperplasia)
• One or more of the endocrine glands are overactive or have formed a tumor (multiple endocrine neoplasia type I)
• Pituitary is making too much ACTH (Cushing disease), which is usually caused by a non-cancerous tumor of the pituitary gland
• Rare type of tumor (lung, thyroid, or pancreas) making too much ACTH (ectopic Cushing syndrome)

A lower-than-normal level of ACTH may indicate:

• Glucocorticoid medicines are suppressing ACTH production (most common)
• Pituitary gland not producing enough hormones, such as ACTH (hypopituitarism)
• Tumor of the adrenal gland that produces too much cortisol
• A normal response after taking the low-dose dexamethasone suppression test

There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Serum adrenocorticotropic hormone; Adrenocorticotropic hormone; Highly-sensitive ACTH

Guber HA, Oprea M, Russell YX. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 25.

Melmed S. Pituitary masses and tumors. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.

Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.