Traditional ACTH Stimulation Test

Indication: Diagnosis of primary adrenal insufficiency.

Procedure:

1. Insert saline lock into peripheral vein
2. Obtain baseline blood samples for ACTH and Cortisol
3. ACTH (purple top tube on ice) and Cortisol (red top tube)
4. Inject 250 mcg Cortrosyn IV through saline lock or IM
5. Inject 3cc NaCL through saline lock to prevent blood from clottings
6. Waste 5 cc of blood prior to 60 minute blood sample collection
7. Obtain a repeat serum Cortisol level at 60 minutes (red top tube)
8. Discontinue saline lock

Interpretation: A rise in Cortisol levels to greater than 20ug/dl within 60 minutes demonstrates a normal result. A rise in Cortisol levels to less than 20ug/dl within 60 minutes suggests that the patient has adrenal failure, as the adrenal glands were inadequately stimulated by pituitary ACTH or that the patient has chronically suppressed adrenal glands. A corresponding high ACTH suggests primary adrenal failure.