The ACTH (Adrenocorticotropic Hormone) Test is a blood test that measures the amount of ACTH in your blood. ACTH is a hormone produced by the pituitary gland in the brain. 🧠 The Hypothalamic-Pituitary-Adrenal (HPA) Axis To understand the ACTH test, it's essential to know about the HPA axis, which is a complex feedback system involving three glands: Hypothalamus: Releases Corticotropin-Releasing Hormone (CRH). Pituitary Gland: Stimulated by CRH, it releases ACTH. Adrenal Glands: Stimulated by ACTH, they release cortisol (and other adrenal hormones). Cortisol is a vital "stress hormone" involved in metabolism, immune response, blood pressure regulation, and more. When cortisol levels rise, they feed back to the hypothalamus and pituitary to inhibit CRH and ACTH production, creating a finely tuned balance. 📝 What the Test Measures The ACTH test measures the level of ACTH, which helps to evaluate the function of the pituitary gland and adrenal glands and to determine the cause of imbalances in cortisol production. ⏰ Importance of Timing ACTH levels fluctuate throughout the day in a diurnal rhythm: They are highest in the early morning (around 6-8 AM). They gradually decrease throughout the day. They are lowest in the late evening/night. Therefore, the timing of the blood draw for an ACTH test is crucial, usually performed in the morning when levels are at their peak. 🩺 Clinical Significance The ACTH test is used to diagnose and differentiate various conditions affecting the HPA axis, primarily related to excess or deficiency of cortisol.

The 24-hour urinary chloride test is a diagnostic test that measures the total amount of chloride excreted in the urine over a full 24-hour period. Chloride is a major electrolyte that works closely with sodium to help maintain the body's fluid balance, blood volume, and acid-base (pH) balance. Purpose of the Test :The test is primarily used to: Evaluate Electrolyte and Fluid Balance: Assesses the body's balance of chloride, often along with sodium and potassium, to help identify the cause of imbalances. Investigate Metabolic Alkalosis: It is particularly useful in distinguishing the causes of Metabolic Alkalosis (a condition where the body's pH is too alkaline). Low Urine Chloride : Suggests the condition is Chloride-Responsive (e.g., due to vomiting, gastric suction, or remote diuretic use) and will improve with saline (salt) administration. High Urine Chloride : Suggests the condition is Chloride-Resistant (e.g., due to hyperaldosteronism, Cushing's syndrome, or Bartter/Gitelman syndromes). Assess Kidney Function and Salt Intake: Since urinary chloride excretion generally reflects dietary salt (NaCl) intake, it can be used to monitor salt restriction compliance or help evaluate conditions affecting renal salt handling.