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🧪 Angiotensin-Converting Enzyme (ACE)

Parameter	Details
Test Name	Angiotensin-Converting Enzyme (ACE)
Sample Type	Blood (Serum)
Fasting Required?	❌ No fasting required
Normal Range	Varies by lab, typically 8–52 U/L
Also Known As	Serum ACE, SACE

🔬 What Is ACE?

ACE is an enzyme primarily produced by cells in the lungs, though also present in the kidneys, brain, and other tissues. It plays a key role in the Renin-Angiotensin-Aldosterone System (RAAS):

Converts angiotensin I → angiotensin II, a potent vasoconstrictor.
Helps regulate blood pressure and fluid balance.

🧠 Organs/Glands Involved

Organ/System	Role Related to ACE
Lungs	Main site of ACE production
Kidneys	Involved in RAAS regulation
Vascular system	Target tissue for angiotensin II effects

🎯 Why Is the ACE Test Ordered?

ACE levels are not typically used to diagnose hypertension, despite its role in blood pressure regulation. The primary use of this test is:

✅ Diagnosis and Monitoring of Sarcoidosis

Sarcoidosis is an inflammatory disease that leads to granuloma formation, especially in the lungs and lymph nodes. Granulomas release excess ACE, making it a useful biomarker.

📋 Other Conditions with Elevated ACE:

Condition	Comments
Sarcoidosis	Elevated in ~60% of active cases
Tuberculosis	Granulomatous inflammation can mildly elevate ACE
Leprosy	Granulomatous infection
Histoplasmosis	Fungal granulomatous infection
Gaucher's Disease	Lysosomal storage disorder
Amyloidosis	May occasionally cause mild elevation
Hyperthyroidism	Mild elevations possible

📊 Interpretation of Results

Result	Possible Interpretation
High ACE	Active sarcoidosis (especially with lung symptoms); other granulomatous diseases
Normal ACE	Does not rule out sarcoidosis; can be normal in early or inactive disease
Low ACE	May occur in severe chronic illness, hypothyroidism, or ACE inhibitor use

❗ ACE levels are not disease-specific and should always be interpreted in the context of clinical findings and imaging.

🧪 Tests Often Done Alongside ACE

Test	Purpose
Chest X-ray / CT Scan	Evaluate lungs for granulomas in sarcoidosis
Serum Calcium	Elevated in sarcoidosis
Serum Vitamin D (1,25-OH)	May be high in sarcoidosis
Lung Function Tests (PFTs)	Assess impact on respiratory system
Bronchoalveolar Lavage / Biopsy	Definitive diagnosis of sarcoidosis
CRP / ESR	Assess general inflammation

💊 Effect of Medications

ACE Inhibitors (e.g., enalapril, lisinopril) used for hypertension may reduce ACE levels, making the test unreliable if taken during testing.

✅ Summary Table

Test Name	Angiotensin-Converting Enzyme (ACE)
Primary Use	Screen and monitor sarcoidosis
Organs Involved	Lungs, vascular system, kidneys
High Levels May Indicate	Sarcoidosis, TB, leprosy, histoplasmosis
Low Levels May Indicate	Use of ACE inhibitors, hypothyroidism
Paired Tests	Chest imaging, serum calcium, lung biopsy, ESR, CRP

Angiotensin Converting Enzyme (ACE)