Adrenal Corticotropin (ACTH) Stimulation Study, Baseline, Post 30 and Post 60 Minutes


Abbrev Code:CORT30   
Order Code:LAB3407Order Name:Adrenal Corticotropin (ACTH) Stimulation Panel
Order Instructions:Only order at locations able to perform infusions. CORTB (LAB3407), CORT30 (LAB3405) and CORT60 (LAB3406) must be ordered individually because they have different collection times. If 15 minute cortisol is needed, order CORT (LAB61).
Synonyms:Cosyntropin (ACTH) Stimulation Panel; Cortisol
Methodology:Roche: Immunoassay using competition principle
CPT Codes: 82533 x3, 82533 x3
Turnaround Time:Performed and reported 24 hours/day.
Special Instructions:Contact the laboratory to coordinate timed specimen collections prior to giving Cosyntropin.


Collection Instructions

Specimen:Blood
Optimal Volume:2.5 mL
Minimum\Peds Volume:0.6 mL
Container:Green (lithium heparin, gel)
Alternate Containers: Green (lithium heparin, no gel), Green (lithium heparin, gel) on ICE, Red (no gel), Red (gel)
Collection Instructions:Collect baseline cortisol (CORTB, LAB3407) before giving Cosyntropin dose. Collect 2 samples of post-Cosyntropin, 30 minutes post (CORT30, LAB3405) and 60 minutes post (CORT60, LAB3406). Collection of 3 samples is recommended; if only collecting 2 samples, collect baseline and 60 minutes post. Record collection time on specimen.
Time Test Collection Requirements Collection Instructions
Baseline   Cortisol   Collect 2.5 mL, 0.6 mL minimum in a red or gold (gel or no gel) tube Collect baseline cortisol CORTB, LAB3407) before giving Cosyntropin dose, Record collect time on specimen.   Optional: Collect Renin mid-morning after patient has been sitting, standing or walking for at least 2 hours and seated for 5-15 minutes. Normal sodium diet (100-200 mEq/day) for at least three days. Receiving no medications known to affect renin-aldosterone system.
ACTH Collect 2.5 mL, 0.6 mL minimum in a purple (EDTA) tube on ice
Optional: Renin   Collect 4 mL, 2.6 mL in purple tube. Do NOT place on ice.  
Optional: Electrolyte Panel   Collect 2.5, 0.6 mL in green (lithium heparin) tube.
15 minutes
post dose 		Additional Cortisol, if ordered by provider Collect 2.5 mL, 0.6 mL minimum in a red or gold (gel or no gel) tube CORT, LAB61
30 minutes
post dose 		Cortisol   Collect 2.5 mL, 0.6 mL minimum in a red or gold (gel or no gel) tube CORT30, LAB3405
60 minutes
post dose 		Cortisol Collect 2.5 mL, 0.6 mL minimum in a red or gold (gel or no gel) tube CORT60, LAB3406
Causes for Rejection:Baseline sample not drawn immediately prior to giving Cosyntropin.


Processing and Shipping

Specimen Processing:Centrifuge and aliquot 1.25 mL, 0.2 mL minimum. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature, to arrive within 48 hours of collection. Alternatively ship on dry ice.
Stability:Roche: 1 day at room temperature; 4 days refrigerated; 1 year frozen.
Vista: 8 hours at room temperature; 48 hours refrigerated; indefinitely frozen.
Test Performed at or Referral Lab Chemistry  (Roche-UMMC East)


Interpretive

Reference Range:
Baseline 6-10 am: 4-22 μg/dL
4-8 pm: 3-17 μg/dL
30 minutes post-stimulation 21-150 μg/dL
60 minutes post-stimulation 21-150 μg/dL
 
Limitations:Circulating cortisol results from patients receiving Prednisolone or Prednisone therapy may be falsely elevated. Exercise caution with cortisol determinations for patients undergoing therapy with these and structurally related synthetic corticosteroids.
Use:Best used for evaluation of adequacy of adrenal response to stimulation by ACTH.


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