ACE, Serum

Optimal Result: 14 - 82 U/L.

Also Known As: ACE, Serum Angiotensin Converting Enzyme, SACE

The ACE (Angiotensin-converting enzyme) test is a blood test that measures the amount of ACE, an enzyme that plays a role in blood pressure regulation. Higher levels of ACE can be an indicator of sarcoidosis, a complex disease with an unclear cause that typically impacts the lungs and can also involve various organs such as the eyes, skin, nerves, liver, and heart.

Sarcoidosis is characterized by the formation of granulomas—clustered masses of immune cells, inflammatory cells, and fibrous tissue. These granulomas can alter the normal structure of tissues, potentially leading to organ damage and inflammation if they are numerous enough. The presence of these granulomas, especially around their outer edges, can lead to elevated ACE levels in the blood.

A normal ACE level cannot be used to rule out sarcoidosis because sarcoidosis can be present without an elevated ACE level. Findings of normal ACE levels in sarcoidosis may occur if the disease is in an inactive state, may reflect early detection of sarcoidosis, or may be a case where the cells do not produce increased amounts of ACE. ACE levels are also less likely to be elevated in cases of chronic sarcoidosis.

When monitoring the course of the disease, an ACE level that is initially high and then decreases over time usually indicates spontaneous or therapy-induced remission and a favorable prognosis. A rising level of ACE, on the other hand, may indicate either an early disease process that is progressing or disease activity that is not responding to therapy.

Several diagnostic procedures are utilized to confirm sarcoidosis and assess the extent of its effect on the body. These may include blood tests such as a liver panel, a complete blood count (CBC), and measurements of calcium levels in both blood and urine, which can be higher in sarcoidosis patients.

Physical inspections for skin abnormalities, lung function assessments—which are relevant as the lungs are affected in approximately 90% of cases—and bronchoscopy, which involves examining the airway and taking lung tissue samples, are also common. Imaging techniques like chest X-rays and gallium scans, where radioactive gallium detects inflammation, are additional methods. Biopsies might be necessary for the skin, lungs, lymph nodes, and occasionally the liver. An in-depth examination of the eyes, including a slit-lamp examination, might also be performed to check for ocular involvement.

What does it mean if your ACE, Serum result is too low?

High and low levels of ACE may be seen in a variety of conditions other than sarcoidosis. The ACE test, however, is not routinely used to diagnose or monitor these conditions; it has not been shown to be clinically useful.

Decreased ACE levels may also be seen in people with:

- Chronic obstructive pulmonary disease (COPD)

- Lung diseases such as emphysema, lung cancer, cystic fibrosis

- Starvation

- Steroid drug therapy

- Hypothyroidism

What does it mean if your ACE, Serum result is too high?

An increased ACE level in a person who has clinical findings consistent with sarcoidosis means that it is likely that the person has an active case of sarcoidosis, if other diseases have been ruled out. ACE will be elevated in 50% to 80% of those with active sarcoidosis. The finding of a high ACE level helps to confirm the diagnosis.

High and low levels of ACE may be seen in a variety of conditions other than sarcoidosis. The ACE test, however, is not routinely used to diagnose or monitor these conditions; it has not been shown to be clinically useful.

Decreased ACE levels may also be seen in people with:

- Chronic obstructive pulmonary disease (COPD)

- Lung diseases such as emphysema, lung cancer, cystic fibrosis

- Starvation

- Steroid drug therapy

  • Hypothyroidism

ACE has been found in moderately increased levels in a variety of diseases and disorders, such as:

- HIV

- Histoplasmosis (fungal respiratory infection)

- Diabetes mellitus

- Hyperthyroidism

- Lymphoma

- Alcoholic cirrhosis

- Gaucher disease (a rare inherited lipid metabolism disorder)

- Tuberculosis

- Leprosy

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