ACTH (cosyntropin) stimulation test

• Cosyntropin

1. Before: Draw serum cortisol
2. Time 0: ^0.25mg IM/IV over 2min
3. Time 30: Draw serum cortisol
4. Time 60: Draw serum cortisol & give 100mg hydrodortison IVP

^0.125mg if <2yrs old

• Normal Response: Cortisol level doubles from baseline after Cosyntropin administration
• Adrenal Insufficiency: Cortisol level fails to rise after Cosyntropin administration

Treatment

1. Then give either
   1. dexamethasone 6mg IV
   2. OR
   3. Hydrocortisone 100mg IV

Source

2/22/06 DONALDSON (from Pharmacopoeia)

• Emedicine: Adrenal Crisis in Emergency Medicine