ACTH刺激试验

定义

The ACTH刺激试验 measures how well the 肾上腺 respond to adrenocorticotropic hormone (ACTH). ACTH is a hormone produced in the pituitary gland that stimulates the 肾上腺 to release a hormone called cortisol.

选择的名字

Test of adrenal reserve; Cosyntropin stimulation test; Cortrosyn stimulation test; Synacthen stimulation test; Tetracosactide stimulation test

如何执行测试

The test is done the following way:

• 你的血被抽干了.
• You then receive a shot (injection) of ACTH, usually into the muscle in your shoulder. The ACTH may be a man-made (synthetic) form.
• After either 30 minutes or 60 minutes, 或两个, depending on how much ACTH you receive, 你又要抽血了.
• The lab checks the cortisol level in all the blood samples.

You may also have other blood tests, including ACTH, as part of the first blood test. Along with the blood tests, you may also have a 尿皮质醇试验 or 尿17-酮类固醇测试, which involves collecting the urine over a 24小时内. Sometimes the test is done to measure a different hormone called 17-hydroxy progesterone.

How to Prepare for the Test

You may need to limit activities and eat foods that are high in carbohydrates 12 to 24 hours before the test. You may be asked to fast for 6 hours before the test. Sometimes, no special preparation is needed. You may be asked to temporarily stop taking medicines, 比如氢化可的松, which can interfere with the cortisol blood test.

考试的感觉如何

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. 这很快就会消失.

The injection into the shoulder may cause moderate pain or stinging.

Some people feel flushed, nervous, or nauseated after the injection of ACTH.

为什么要进行测试

This test can help determine whether your adrenal and pituitary glands are normal. It is most often used when your health care provider thinks you have an adrenal gland problem, 如 艾迪生疾病, or 垂体功能不全. It is also used to see if your pituitary and 肾上腺 have recovered from prolonged use of glucocorticoid medicines, 如 prednisone or dexamethasone.

正常的结果

An increase in cortisol after stimulation by ACTH is expected. Cortisol level after ACTH stimulation should be higher than 13 to 14 mcg/dL (358 to 386 nmol/L) depending on the type of cortisol assay used and, 使用ACTH的剂量.

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.

异常结果意味着什么

This test is helpful in finding out if you have:

• 急性肾上腺危机 (life-threatening condition that occurs when there is not enough cortisol)
• 艾迪生疾病 (肾上腺 do not produce enough cortisol)
• 垂体机能减退 (pituitary gland is not producing enough hormones 如 ACTH)

风险

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:

• 大出血
• 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)

参考文献

Newell-Price JDC, Auchus RJ. 肾上腺皮质. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14日艾德. Philadelphia, PA: Elsevier; 2020:chap 15.

Torpy DJ, Bancos I, Husebye E. 肾上腺机能不全. In: Robertson RP, ed. DeGroot的内分泌学. 8日艾德. Philadelphia, PA: Elsevier; 2023:chap 93.