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Medical Video: Understanding the Short Synacthen Test
Definition
What is the adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin?
Cosyntropin (Cortrosyn) is an artificial chemical (produced in the laboratory) that has a function similar to the hormone ACTH. This substance can stimulate the adrenal cortex to produce cortisol.
During the test, you will get a shot of Cosyntropin. Then, the doctor / medical expert will monitor the level of cortisol before and after the injection is given. By monitoring cortisol levels, your doctor can determine whether your adrenal cortex is working properly or not.
Increased cortisol levels in plasma after injection of Cosyntropin show that your adrenals respond well to stimulation. In other words, the adrenal is in normal condition and the cause of adrenal insufficiency is the pituitary gland (hypopituitarism / secondary adrenal insufficiency).
Conversely, if there is no increase in cortisol levels after injection of Cosyntropin, the adrenals show abnormalities caused by adrenal insufficiency. This disorder is called the primary adrenal insufficiency (Addison's disease).
In general, adrenal diseases that cause adrenal insufficiency include adrenal hemorrhage, infarction, autoimmune disorders, tumor metastasis, adrenal surgical resection or congenital adrenal enzyme insufficiency.
Tests are also done to diagnose Cushing's syndrome (Cushing's syndrome). Cushing's syndrome is a syndrome that causes adrenal hyperplasia on both sides of the kidney so that there is little or no increase in cortisol levels compared to the initial level.
When should I undergo acth stimulation with cosyntropin?
Your doctor will recommend this test if you show signs and symptoms of adrenal abnormalities. Through tests, your doctor can find out the cause of your adrenals not working effectively, whether caused by adrenal or pituitary abnormalities. In addition, this test is done to diagnose Cushing's disease.
Symptoms of adrenal disorders vary. Although the symptoms are common and can easily be found in other diseases, see a doctor immediately and take a test if you experience:
- drastic weight loss
- low blood pressure
- loss of appetite
- muscles feel weak
- pain in muscles and joints
- the skin darkens
- disposition
- discomfort
Symptoms of increased cortisol in the blood are:
- pimples
- face up
- obesity
- changes in hair thickness and facial hair growth
- irregular menstrual cycle in women
Prevention & warning
What should I know before undergoing acth stimulation with cosyntropin?
Some drugs can change the level of cortisol in the blood, including inflammatory drugs that contain steroids, estrogen and spironolactone.
It is possible that the doctor will advise you to do a rapid test. Even though the results are normal, the possibility of adrenal insufficiency is still present.
The adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin takes 24 hours to 3 days to distinguish between primary and secondary insufficiency.
Keep in mind that adrenals can be stimulated by hypoglycemia with insulin.
Pay attention to warnings and precautions before undergoing this treatment. If you have questions, please consult a doctor for further information and instructions.
Process
What should I do before undergoing acth stimulation with cosyntropin?
At night before the test, you must fast first. The doctor will check your health condition. Discuss with your doctor about certain preparations before taking the test. You are recommended to use short-sleeved clothing to make it easier to take blood samples from your hands.
How is the acth stimulation process with cosyntropin?
Rapid test (Rapid test)
Medical procedure:
- measure initial cortisol levels in plasma. It takes 30 minutes before injecting Cosyntropin (a substance similar to ACTH)
- injects Cosyntropin into a vein within 2 minutes according to the procedure
- measure the level of cortisol in plasma after 30 and 60 minutes taking the drug
- collect plasma into a test tube with a red lid to measure cortisol levels
24 hour test (24-hour test)
Medical procedure:
- measure initial cortisol levels in plasma
- give synthetic Cosyntropin injections into the vein
- use certain fluids (as prescribed) within 24 hours
- after 24 hours, the medical professional will again measure plasma cortisol levels
- collect plasma in a test tube with a red lid to measure cortisol levels
3 day test (3-day test)
Medical procedure:
- measure initial cortisol levels in plasma
- transfer Cosyntropin in certain doses through veins with an interval of 8 hours on 2-3 consecutive days
- measure plasma cortisol levels in the 12, 24, 36, 48, 60, and 72 hours after the test begins
- collect plasma in a test tube with a red lid to measure cortisol levels
What should I do after undergoing acth stimulation with cosyntropin?
Some people may feel pain when a syringe is inserted into the skin. But for most people, the pain will gradually disappear when the needle is right in the vein. Generally, the level of pain experienced depends on the expertise of the nurse, the condition of the arteries, and a person's sensitivity to pain.
After going through the process of taking blood, wrap your hands in a bandage. Press the vein slowly to stop bleeding. After doing the test, you can do activities as usual.
If you have questions about the test process, please consult a doctor for further instructions.
Explanation of Test Results
What do the test results mean?
Normal
Rapid test: Cortisol increases 7 mcg / dL from the initial level.
24 hour test (24-hour test): The cortisol level is higher than 40 mcg / dL.
3-day test (3-day test): Cortisol level is higher than 40 mcg / dL.
Abnormal
Adrenal insufficiency
If the cortisol level is higher than the secondary adrenal insufficiency, chances are you have:
- Addison's disease
- adrenal infarction / bleeding
- tumor metastasis in the adrenal gland
- congenital adrenal enzyme insufficiency
- surgical removal of the adrenal gland
Chusing's syndrome
If the level of cortisol is higher than normal, you may also experience adrenal hyperplasia on two adrenal sides.
However, if the response rate is normal or lower than normal (primary adrenal insufficiency), chances are you have:
- adrenal tumor
- adrenal carcinoma
- tumors that are not related to adrenals but can produce ACTH
The doctor will explain the results of this test and combine it with the results of other tests to provide a specific diagnosis. You can ask the doctor for more information.
The normal range for the adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin can vary depending on the laboratory you choose. Please discuss with your doctor if there are questions about your test results.
Hello Health Group does not provide medical advice, diagnosis or treatment.
