Acth stimulation with cosyntropin & bull; hello healthy

Definition

What is the adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin?

Cosyntropin (Cortrosyn) is an artificial chemical (produced in a laboratory) that has a similar function to the ACTH hormone. This substance can stimulate the adrenal cortex to produce cortisol.

During the test, you will get an injection of Cosyntropin. Then, the doctor / medical professional will monitor the cortisol level 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 plasma cortisol levels after Cosyntropin injection indicates that your adrenals are responding well to stimulation. In other words, the adrenals are 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 Cosyntropin injection, then the adrenals will show abnormalities caused by adrenal insufficiency. This disorder is known as primary adrenal insufficiency (Addison's disease).

In general, adrenal diseases that cause adrenal insufficiency include adrenal hemorrhage, infarction, autoimmune disorders, metastatic tumors, 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 of both sides of the kidney so that there is little or no increase in cortisol levels compared to baseline levels.

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 why your adrenals are not working effectively, either due to adrenal or pituitary disorders. Additionally, 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 get tested if you experience:

• weight loss drastically
• low blood pressure
• loss of appetite
• muscles feel weak
• pain in muscles and joints
• darkened skin
• disposition
• discomfort

Symptoms of an increase in cortisol in the blood are:

• acne
• round face
• obesity
• changes in hair thickness and hair growth on the face
• irregular menstrual cycle in women

Precautions & warnings

What should I know before undergoing acth stimulation with cosyntropin?

Several medications 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 (rapid test). Even though the results are normal, the possibility of adrenal insufficiency is still there.

The adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin takes 24 hours to 3 days to differentiate between primary and secondary insufficiency.

It should be noted that the adrenals can be stimulated by hypoglycemia with insulin.

Observe warnings and precautions before undergoing this treatment. If you have any questions, please consult a doctor for further information and instructions.

Process

What should I do before undergoing acth stimulation with cosyntropin?

On the night before taking the test, you must fast first. The doctor will check your health condition. Talk to your doctor about certain preparations before taking the test. It is recommended that you wear short-sleeved clothing to make the process of taking a blood sample from your hand easier.

How is the acth stimulation process with cosyntropin?

Rapid test

Medical expert procedures:

• measure the initial plasma cortisol level. It takes 30 minutes before injecting Cosyntropin (a substance similar to ACTH)
• give Cosyntropin injection into a vein within 2 minutes according to the procedure
• measure the level of cortisol in plasma after 30 and 60 minutes of taking the drug
• collect plasma into a test tube with a red cap to measure the cortisol level

24 hour test (24-hour test)

Medical expert procedures:

• measure the initial plasma cortisol level
• give an injection of synthetic Cosyntropin into a vein
• using certain fluids (as prescribed) within 24 hours
• After 24 hours, the medical professional will again measure the level of cortisol in plasma
• collect plasma in a test tube with a red cap to measure cortisol levels

3-day test

Medical expert procedures:

• measure the initial plasma cortisol level
• perform a certain dose of Cosyntropin transfer via a vein with an interval of 8 hours on 2-3 consecutive days
• measured plasma cortisol levels 12, 24, 36, 48, 60, and 72 hours after starting the test
• collect plasma in a test tube with a red cap to measure cortisol levels

What should I do after undergoing acth stimulation with cosyntropin?

Some people may feel pain when the needle is inserted into the skin. But for most people, the pain will fade away when the needle is right in the vein. Generally, the level of pain experienced depends on the nurse's expertise, the condition of the blood vessels, and the person's sensitivity to pain.

After going through the blood draw process, wrap your hands with a bandage. Press the vein lightly to stop the bleeding. After doing the test, you can carry out your activities as usual.

If you have any questions regarding the test process, please consult your doctor for further instructions.

Explanation of the Test Results

What do my test results mean?

Normal

Rapid test (rapid test): Cortisol increased 7 mcg / dL from the initial level.

24-hour test: Cortisol levels higher than 40 mcg / dL.

3-day test: Cortisol level higher than 40 mcg / dL.

Abnormal

Adrenal insufficiency

If your cortisol levels are higher than normal (secondary adrenal insufficiency), you may have:

• Addison's disease
• adrenal infarction / bleeding
• tumor metastases of the adrenal glands
• congenital adrenal enzyme insufficiency
• surgical removal of the adrenal glands

Chusing's syndrome

If your cortisol levels are higher than normal, you may also have adrenal hyperplasia on both sides of your adrenals.

However, if the response rate is normal or lower than normal (primary adrenal insufficiency), you may have:

• adrenal tumor
• adrenal carcinoma
• tumors that are not related to the adrenals but can produce ACTH

The doctor will explain the results of these tests and combine them with other test results to provide a specific diagnosis. You can ask the doctor for more details.

The normal range for the adrenocorticotropic hormone (ACTH) stimulation test with Cosyntropin may vary depending on the laboratory you choose. Please discuss with your doctor if you have any questions about your test results.