Clinical Procedures

ACTH STIMULATION TEST (Short synacthen test):
This test is done to detect adrenocortical insufficiency (low plasma cortisol concentration) which could be primary due to defects in adrenal cortex or secondary to ACTH deficiency. Plasma ACTH levels are high in Addison's disease and low in ACTH deficiency which is detected by finding a subnormal response to the administration of exogenous ACTH. Injection of adequate dose of Synacthen is followed by marked cortisol secretion by adrenal cortex.

Prerequisites:
Patient should be instructed to come at 8-9am in the morning.

No special instructions required. Fasting is not needed. Glucocorticoid medications should be ceased.

Contraindication:
Suspected Cushing syndrome, pregnancy, viral infections, heart failure, and allergy.

Interpretation:
Normal response is

• Post stimulation value of >200nmol/L from basaline.
• Post stimulation value >550nmol/L

Schedule:
This test is done through out the week

Sample collection:
Initially a baseline cortisol sample is taken after which patient is given an intravenous injection of synachten (ACTH). Then subsequent samples are taken at 30 and 60 minutes.