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Cortrosyn Stimulation Test

Short ACTH Test, Synthetic a 1-24-ACTH Stimulation Test, Cortisol, Cosyntropin

Test Codes

EPIC: LAB5033, CORST

Department

Chemistry

Instructions

• This test is available BY APPOINTMENT ONLY.
  


• Inpatient requests are performed Monday – Friday, 7:00 am – 3:00 pm.
  
  
  • Royal Oak:  Tests are performed by the Department of Nuclear Medicine. Contact 248-898-4094 for an appointment.
    
  • Farmington Hills & Troy:  Tests are performed by nursing and physician staff with laboratory performing the blood draws as needed. Contact Farmington Hills at 248-471-8252, and Troy at 248-964-8070.
  • Dearborn:  Tests are performed by nursing and physician staff with laboratory performing the blood draws as needed. Contact 313-593-7994 for assistance with blood draws.
  • Taylor:  Tests are performed by nursing and physician staff with laboratory performing the blood draws as needed. Contact 313-295-5368 for assistance with blood draws.
  • Trenton:  Tests are performed by nursing and physician staff with laboratory performing the blood draws as needed. Contact Trenton 734-671-3866 for assistance with blood draws.
  • Wayne:  Tests are performed by nursing and physician staff with laboratory performing the blood draws as needed. Contact 734-467-4234 for assistance with blood draws.


• Outpatient requests are scheduled Monday – Friday, as indicated below. Walk-in patients are not accepted.
  
  
  • Royal Oak: Tests are performed in the Infusion Center. Contact 248-551-5490, select option 2 (for the Infusion Center), to make an appointment.
  • Troy: Tests are performed in the Ambulatory Infusion Center, East Campus, Sterling Heights. For an appointment, fax the patient prescription to 248-964-2409. For further information, contact the AIC at 248-964-3080.
  • Farmington Hills, Dearborn, Taylor, Trenton, and Wayne:  Testing not available.


• Three sequential serum specimens are collected for Cortisol; at baseline (before injection), and then at 30 minutes and 60 minutes following the injection of Cortrosyn IM.

Specimen Collection Criteria

Collect: One Gold-top SST tube at each time interval, as indicated in the instructions above.

• Indicate 0 (baseline), 30, or 60 minutes on the specimen.
• If testing is performed by physician or nursing staff, order "Cortrosyn Stimulation Test" in EPIC.
• Send the three blood samples (labeled with draw times) together to Specimen Processing.

Rejection Criteria

Specimens not collected and processed as indicated. Consult a pathologist or technical director in Automated or Special Chemistry prior to specimen rejection or test cancellation for any timed test.  

In-Lab Processing

Let SST specimens clot 30–60 minutes. Centrifuge SST tubes or Microtainers^® to separate serum from cells. Deliver immediately to the appropriate testing station.

Storage

Specimen Stability for Testing:

Centrifuged SST Tubes and Microtainers^® with Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 8 hours
Refrigerated (2–8°C or 36–46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Red-top Tubes and Microtainers^® without Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2-4 hours
Refrigerated (2–8°C or 36–46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20–26°C or 68–78.8°F): 8 hours
Refrigerated (2–8°C or 36–46°F): 7 days
Frozen (-20°C/-4°F or below): 7 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2–8°C or 36–46°F): 7 days

Laboratory

Farmington Hills Chemistry Laboratory
Royal Oak Automated Chemistry Laboratory
Troy Chemistry Laboratory
Dearborn Chemistry Laboratory
Taylor Chemistry Laboratory
Trenton Chemistry Laboratory
Wayne Chemistry Laboratory

Performed

Monday – Friday, as indicated in Instructions.
Cortisol results are available within 24 hours of receipt in the Laboratory. A pathologist's interpretation will follow. 

Reference Range

Normal Cortrosyn Stimulation: A rise from the baseline serum cortisol result to a value of at least 14 mcg/dL.

Test Methodology

A baseline blood sample is drawn for a serum cortisol assay prior to the injection of Cortrosyn. The patient is given 250 mcg of Cortrosyn IM and then sequential serum samples are drawn for cortisol at 30 and 60 minutes.

If requested, 17 OH-Progesterone may be ordered and collected at the same time.

Interpretation

Cortrosyn is an alpha-1–24 corticotropin, a synthetic subunit of ACTH. Severe hypofunction of the pituitary-adrenal axis is usually associated with subnormal serum cortisol values, but a low basal level is not per se evidence of adrenal insufficiency and does not suffice to make the diagnosis. Also, many patients with proven insufficiency will have normal basal levels and will develop signs of insufficiency only when stressed. For this reason, the only criterion that should be used in establishing the diagnosis is the failure to respond to adequate corticotropin stimulation as provided by 0.25 mg of Cortrosyn.

When presumptive adrenal insufficiency is diagnosed by a subnormal Cortrosyn test, further studies are indicated to determine if it is primary or secondary. The differentiation of both types is based on the premise that a primary defective gland cannot be stimulated by Cortrosyn whereas a secondarily defective gland is potentially functional and will respond to adequate stimulation with Cortrosyn upon treatment with repository corticotropin prior to testing with Cortrosyn.

Contraindications:

• Patients should not be taking corticosteroids unless the physician is aware and desires to specifically test the patient while on dose.
• A history of a previous adverse reaction to Cortrosyn or ACTH.
• Pregnancy: Animal reproduction studies have not been conducted with Cortrosyn. It is also not known whether Cortrosyn can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Cortrosyn should be given to a pregnant woman only if clearly needed.
• Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Cortrosyn is administered to a nursing woman.

Clinical Utility

Cortrosyn Stimulation Testing can assist in the diagnosis of adrenocortical insufficiency.

CPT Codes

82533 x 3.
LOINC: 2143-6, 26530-6, 26528-0

Contacts

Last Updated

1/20/2023