From: Subject: Cortrosyn Stimulation Test Date: Wed, 19 Mar 2008 16:40:34 -0400 MIME-Version: 1.0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: mhtml:file://L:\LABGEN\PROC\LabHelp_Web_Docs\Collection%20Information\Cortrosyn%20Stimulation%20Test.mht X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3198 Cortrosyn = Stimulation Test

Cortrosyn Stimulation Test

General

For Adults: After a baseline cortisol has been = collected,=20 an IV or IM dose of 0.25 mg of synthetic ACTH (Cortrosyn) is administered. Additional cortisol specimens = are then=20 collected at 30 and 60 minutes after the injection.

Refer to the Cortrosyn package=20 insert for pediatric patient dosing.

Preparation

Fasting is not required for this test. This = procedure=20 should be scheduled in the morning if possible.

Ordering

This test is ordered as 3 Timed Plasma Cortisol = Levels.=20

Procedure

For Adults: The patient's nurse should be = prepared to=20 administer 0.25 mg of Cortrosyn IV or IM = (dispensed by=20 pharmacy) after the baseline sample has been collected.

The baseline sample is collected and the time = noted on the=20 requisition or sample tube.

The injection is given and the time noted.

A cortisol sample is then collected at exactly 30 = minutes=20 and at 60 minutes after injection. The exact time of collection must be = noted on=20 all samples

Interpretation

The usual normal response in most cases is an = approximate=20 doubling of the basal cortisol level, provided that the basal level does = not=20 exceed the normal range. Many patients with normal adrenal function, = however, do=20 not respond to the expected degree so that the following criteria have = been=20 established to denote a normal response:

1. =20 The baseline plasma cortisol level should = exceed=20 5 micrograms/100 mL.

2. =20 The 30-minute level should exceed 18=20 micrograms/100 mL.

3. =20 The 30-minute level should show an = increment of=20 at least 7 micrograms/100 mL above the baseline level.

Plasma cortisol levels usually peak about 45 to = 60 minutes=20 after an injection of CORTROSYN.

A normal response rules out primary and overt = secondary=20 adrenal insufficiency. A subnormal response indicates decreased = adrenal=20 reserve and a diagnosis of insufficiency, either primary to adrenal = failure=20 (e.g. Addison's disease) or secondary to pituitary disease or = suppression by=20 steroid medications. A normal response does not rule out partial = secondary=20 adrenal insufficiency in patients who cannot maintain sufficient basal = ACTH to=20 respond to stress or hypoglycemia.

In adrenal hyperplasia there is 3 to 5 fold increase, in adrenal = carcinoma=20 there is little or no response.

Document=20 Control

Facility: Central Maine = Medical=20 Center, 300 Main Street, Lewiston, Maine =20 04240 =20

Document = Path\Filename: L:\LABGEN\PROC\LabHelp_Web_Docs\Collection=20 Information\Cortrosyn Stimulation=20 Test.mht

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