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Introduction ⬇

This detects adrenal insufficiency after cosyntropin administration. Cosyntropin is a synthetic subunit of ACTH that exhibits the full corticosteroid-stimulating effect of ACTH in healthy persons. Failure to respond is an indication of adrenal insufficiency. See foregoing cortisol tests for values. This screening test is less time-consuming and can be done on an outpatient basis.

  1. Have patient resume normal activities.

  2. Review test results and monitor appropriately for adrenal insufficiency. Report and record findings. Modify the nursing care plan as needed.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

With adrenal hyperplasia, there is an increase of cortisol levels of three to five times normal; with adrenal carcinoma, there is no increase

Normal Findings ⬆ ⬇

Cortisol: 20 μg/dL (>552 nmol/L) rise after cosyntropin administration

Procedure ⬆ ⬇

  1. Obtain a 4-mL fasting venous blood sample (red-topped tube) at 8:00 a.m. (0800 hours) Observe standard precautions.

  2. Administer cosyntropin intramuscularly or intravenously as prescribed.

  3. Obtain additional 4-mL blood specimens 30 and 60 minutes after administration of cosyntropin. Serum or heparinized blood is acceptable.

Clinical Implications ⬆ ⬇

  1. Absent or blunted response to cortisol stimulation occurs in the following conditions:

    1. Addison disease (adrenal insufficiency)

    2. Hypopituitarism (secondary adrenal insufficiency)

    3. Adrenal carcinoma, adenoma

  2. Response to cortisol stimulation: adrenal hyperplasia

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure. Fasting during test is required. Blood specimens are obtained before and after intramuscular (IM) injection of cosyntropin.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆

  1. Prolonged steroid administration

  2. Estrogens (see Appendix E)