ACTH Test

ACTH also known as adrenocorticotropic hormone is a hormone produced by the pituitary gland. This hormone in turn regulates the production of another important hormone cortisol, made by adrenal glands. Cortisol, known as a 'stress hormone', controls varied reactions in our body that take place in response to stress. Cortisol regulates blood pressure and blood sugar levels in the body and helps in maintaining immune function and anti-inflammatory processes. ACTH travels through the bloodstream to the adrenal glands and stimulates the adrenals to release cortisol. An ACTH blood test is done to measure the level of the adrenocorticotropic hormone in the blood.

Too much or too little ACTH level reveals problems related to adrenal glands or pituitary glands. High level of ACTH points to problems with adrenal glands and low level of ACTH may imply defective pituitary glands. The results of ACTH test is extremely useful in diagnosing Cushing syndrome and adrenal insufficiency.

Higher values of ACTH test are associated with one of the following conditions:

• Addison's disease
  
  
• Adrenal Hyperplasia
  
  
• Cushing's disease
  
  
• Tumor in the adrenal glands or pituitary glands
  
  
• Ectopic ACTH, which means ACTH made by a tumor outside the pituitary gland

Lower levels of ACTH could mean adrenal tumor, Exogenous Cushing syndrome or hypopituitarism, a pituitary dysfunction leading to little or no production of hormone.

Preparing for the test

Patient should not eat or drink for 10 hours prior to the test. It is advisable to take a diet low in carbohydrates for two to three days before the test. Exercise and alcohol should be avoided for 12 hours before the test. Few steroid medications result in low levels of ACTH, hence patient should share all the information regarding the current medication with the doctor. Patient should not have undergone any medical test that uses a radioactive tracer for a week before an ACTH test.

ACTH levels do not remain in the same range through the day. The plasma ACTH levels are highest in the morning and start to decline during the waking hours. Therefore, blood is usually collected in the morning hours or multiple blood samples are sought for accurate diagnosis.

The Normal reference range is as follows:

Morning: Less than 80 pg/mL or less than 18 pmol/L

Evening: Less than 50 pg/mL or less than 11 pmol/L

A significant deviation from the normal range could mean defective adrenal glands or pituitary gland and further investigation is ordered for the accurate diagnosis.

Hirsutism

Hirsutism is a condition where a woman has male-pattern hair growth. It results in excessive coarse dark hair where women don't generally have hair, such as the face, chest and back. It can happen due to high androgen levels or increased skin sensitivity to androgens caused due to certain medical conditions. Else it could be traced to ethnicity and genes.

Excessively high androgen levels are most often the cause for Hirsutism. Some signs of virilization might be noticed along with Hirsutism such as acne, balding, deepening voice, enlarged clitoris and reduced breast size. Other causes include:

• PCOS- Polycystic Ovarian Syndrome
  
  
• Cushing's Syndrome H- or Hypercortisolism as it is known owing to the high levels of cortisol in the body.
  
  
• Tumor
  
  
• Acromegaly - A hormonal disorder that results from excessive secretion of growth hormone.
  
  
• Congenital adrenal hyperplasia
  

Tackling Hirsutism

Anti-androgens are often prescribed to block the androgen effect thereby reducing the excessive hair growth. The effect is slow as the hair takes about 6 months to get thinner and less noticeable. Oral contraceptives, Finasteride, Spironolactone and Cyproterone are commonly prescribed anti-androgens.

Women resort to waxing and shaving to get rid of unwanted hair. Depilatories and eflornithine cream are also self-care options. Laser treatment or IPL (Intense Pulsed Treatment) are undertaken to destroy the hair root permanently. They are done over several sittings and must be done under qualified practitioners.

Precocious Puberty

Precocious puberty is an uncommon condition that occurs when puberty begins before the age of eight in girls and before age nine in boys. The signs and symptoms of precocious puberty:

In Girls:

• Development of breasts
  
• Hair development underarm or in public parts
  
• Rapid height growth
  
• Onset of menstruation
  
• Acne
  
• Adult body odor

In Boys:

• Enlargement of testicles
  
• Hair growth in face (usually grows first on the upper lip), public parts /underarm
  
• Rapid height gain
  
• Deepening of voice
  
• Acne
  
• Adult body odor

In some children 'partial' precocious puberty could be seen. Girls may show breast development that later disappears or may persist without any other physical changes of puberty. Such children with partial precocious puberty should be evaluated by a medical professional to rule out any other health problems. By and large such instances do not require any treatment and usually will show the other expected signs of puberty at the right age.

Causes for Precocious Puberty

Abnormalities in ovary and testicles may contribute to precocious puberty. Problems in the ovaries, thyroid gland disorders can also cause the onset of puberty ahead of schedule. Sometimes precocious puberty is the result of a structural problem in the brain such as a tumor, brain injury due to head trauma, infection such as meningitis that triggers puberty to begin early. In a majority of girls there is no underlying medical problem but they simply start puberty too early for no known reason. Certain types of environmental contamination like environmental toxins could play a role in causing precocious puberty.

Central precocious puberty

• Tumor in the brain or spinal cord
  
• Infection such as encephalitis or meningitis
  
• A birth defect in the brain such as hydrocephalus or hamartoma (tumor)
  
• Radiation to brain or spinal cord
  
• Injury to brain or spinal cord
  
• Ischemia
  
• McCune Albright Syndrome - a genetic disease that affects the bones and skin color and causes hormonal problems
  
• A group of inherited disorders known as Congenital adrenal hyperplasia which involves abnormal hormone production by the adrenal glands.
  
• Hypothyroidism