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Synonyms
- Addison's Disease Test
- Compound F (Two Specimens)
- Cortisol (Two Specimens)
- Cosyntropin Stimulation
- Hydrocortisone (Two Specimens)
Special Instructions
Draw blood for baseline cortisol. Inject cosyntropin 250 μg IM or IV (if IV, dilute cosyntropin in 2-5 mL of sterile saline and inject over two minutes). Draw blood for stimulated cortisol 60 minutes after.1-3
Treatment for patients in suspected adrenal crisis should not be delayed while waiting for the results of ACTH (cosyntropin) stimulation testing.3,4 Formal confirmation of diagnosis can be carried out after clinical recovery.
Expected Turnaround Time
1 - 2 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Related Documents
Specimen Requirements
Specimen
Serum
Volume
1.0 mL (each specimen)
Minimum Volume
0.7 mL (each specimen). (Note: This volume does not allow for repeat testing.)
Container
Red-top tube or gel-barrier tube
Collection
If tube other than a gel-barrier tube is used, transfer separated serum to a plastic transport tube. Note: Label each tube with the patient's name, collection time, and date. Submit specimens simultaneously on the same test request form.
Storage Instructions
Room temperature
Stability Requirements
Temperature | Period |
|---|---|
Room temperature | 14 days |
Refrigerated | 14 days |
Frozen | 14 days |
Freeze/thaw cycles | Stable x3 |
Causes for Rejection
Plasma specimen
Test Details
Use
Evaluation of possible primary and secondary adrenal insufficiency.1-3,5
Limitations
Pregnancy, contraceptives, and estrogen therapy can give rise to elevated cortisol concentrations. In samples from patients who have been treated with prednisolone,methylprednisolone, or prednisone, falsely elevated concentrations of cortisol may be determined due to cross-reactivity.6 Patients suffering from 21-hydroxylase-deficiency exhibit elevated 21-deoxycortisol levels, and this can also give rise to elevated cortisol levels.6 Severe stress can also give rise to elevated cortisol concentrations.6
As with all tests containing monoclonal antibodies, erroneous findings may be obtained from patients who have been treated with monoclonal mouse antibodies or who have received them for diagnostic purposes. In rare cases, interference due to extremely high titers of antibodies to streptavidin and ruthenium can occur. The test contains additives, which minimize these effects.
Methodology
Electrochemiluminescence immunoassay (ECLIA)
Additional Information
The ACTH stimulation test (Cosyntropin) is used to assist in diagnosing primary and secondary adrenal insufficiency. Cosyntropin (ACTH 1-24) consists of the first 24 amino acids of the N-terminal portion of the intact native ACTH molecule (ACTH 1-36). It is the biologically active region of intact ACTH and is less allergenic than other forms of ACTH.7,8 It acts rapidly when bound to the melanocortin-2 receptor (MC2R) of the adrenal cortex initiating synthesis and release of cortisol and its precursors. The magnitude and duration of response as measured by serum steroid levels may depend on the prior stimulation or suppression of the hypothalamic-pituitary-adrenal axis and the adequacy of drug administration.
Interpretation: A normal response is a rise from the baseline of cortisol, reaching at least 14.5 μg/dL 30 or 60-minutes post stimulation.9 A blunted or absent response suggests some level of adrenal insufficiency, cortical atrophy or significant suppression. Results should be interpreted within the context of patient’s medical history and clinical symptoms, particularly for patients with results near the cutoff.
Footnotes
1. Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-226.25098712
2. Raff H, Sharma ST, Nieman LK. Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing’s syndrome, adrenal insufficiency, and congenital adrenal hyperplasia. Compr Physiol. 2014 Apr;4(2):739-769.24715566
3. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364-389.26760044
4. Melmed S, Auchus RJ, Goldfine AB, Koening, RJ, Rosen CJ. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier/Saunders; 2020;p524-526.
5. Dekkers OM, Timmermans JM, Smit JW, Romijn JA, Pereira AM. Comparison of the cortisol responses to testing with two doses of ACTH in patients with suspected adrenal insufficiency. Eur J Endocrinol. 2011 Jan;164(1):83-87.21036888
6. Elecsys Cortisol II (on cobas e801) [package insert]. Indianapolis, IN: Roche Diagnostics; 2021; 2021-05, V 2.0.
7. Landon J, Wynn V, James VH, Wood JB. ADRENAL RESPONSE TO INFUSED CORTICOTROPIN IN SUBJECTS RECEIVING GLUCOCORTICOIDS. J Clin Endocrinol Metab. 1965 May;25:602-611.14313754
8. Wood JB, Franklin AW, James VH, Landon J. A RAPID TEST OF ADRENOCORTICAL FUNCTION. Lancet. 1965 Jan 30;1(7379):243-245.14238068
9. Javorsky BR, Raff H, Carroll TB, et al. New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays. J Endocr Soc. 2021 Feb 18;5(4):bvab022.33768189
LOINC® Map
| Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
|---|---|---|---|---|---|---|
| 140761 | Cortisol, ACTH Stimulation | 34541-3 | 140792 | Cortisol Baseline | ug/dL | 43215-3 |
| 140761 | Cortisol, ACTH Stimulation | 34541-3 | 140793 | Cortisol Stimulated | ug/dL | 34476-2 |
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