Low-Dose ACTH Stimulation Test

Indication: Diagnosis of central adrenal insufficiency.

Procedure:

1. Insert saline lock into peripheral vein
2. Obtain blood samples for baseline serum cortisol (red top tube)
3. Mix 250mcg Cortrosyn to 250ml 0.9% NaCL
4. Inject 1.0ml of the mixture IV (not IM) through saline lock
5. Inject 3cc 0.9% NaCL into saline lock to prevent blood from clotting
6. Waste 5cc blood at 30 minutes
7. Obtain a repeat serum cortisol level at 30 minutes (red top tube)

Interpretation: A rise in serum cortisol to greater than 18ug/dl within 30 minutes suggests a normal result. A serum cortisol of less than 18ug/dl suggests the presence of central adrenal insufficiency.