The ACTH Test's Dark Side in Sepsis

Sepsis is a serious condition where the body's response to an infection causes widespread inflammation. This can lead to organ failure and even death. Doctors often use the ACTH test to check if a patient's adrenal glands are working properly. These glands produce hormones that help the body deal with stress, like an infection. The ACTH test looks for a condition called adrenal insufficiency, where the glands don't make enough hormones. In sepsis, this is often referred to as relative adrenal insufficiency (RAI) or critical illness-related corticosteroid insufficiency (CIRCI). Doctors used to think that giving extra hormones, like corticosteroids, to these patients could help. But, recent research shows that the ACTH test might not be as reliable as we thought. The ACTH test has been used for a long time to diagnose adrenal insufficiency. But, new studies show that it might not be the best tool for the job. In fact, it might even make things worse. Researchers found that the ACTH test can cause a dangerous increase in inflammatory cytokines. These are molecules that help the body fight infection, but too much can be harmful. In septic mice, the ACTH test led to higher mortality rates. This suggests that the test might be causing more harm than good. The ACTH test might be giving doctors the wrong information. It can identify mice as having adrenal insufficiency, even when their adrenal stress response is normal. This could lead to unnecessary treatment with corticosteroids. These hormones can have serious side effects, especially in critically ill patients. So, doctors might be treating patients who don't need it, and missing those who do. The ACTH test's flaws might explain why some clinical trials on corticosteroid therapy have been inconclusive. These trials didn't show a clear benefit of the therapy. But, maybe the problem isn't the therapy itself. Maybe it's the test that's leading doctors astray. It's clear that more research is needed. Doctors need better tools to diagnose adrenal insufficiency in sepsis patients. Until then, they should be cautious when using the ACTH test. And, they should think carefully about when to use corticosteroid therapy.