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HelpTest Code ACTH Stim, 30 and 60 Min Cort ACTH Stimulation, 30 and 60 Min Cortisols
Synonyms/Keywords
Cosyntrophin Stimulation Test, Adrenocorticol (ACTH) Stimulation Test, Cortrosyn Stimulation Test, Cortisol
Specimen Requirements
| Fasting Required | Specimen Type | Preferred Container/Tube | Acceptable Container/Tube | Specimen Volume | Specimen Minimum Volume (allows for 1 repeat) |
Pediatric Minimum Volume (no repeat) |
|---|---|---|---|---|---|---|
| No | Plasma/Serum | Lithium Heparin Plasma Separator Tube (PST) | Lithium Heparin Green Top Tube (GTT), EDTA Lavender Top Tube (LTT), Serum Separator Tube (SST), Red Top Tube (RTT) | 0.5 mL | 0.4 mL | 0.3 mL |
- GTT/RTT- physically separate plasma or serum from contact with cells as soon as possible of before transport. Separate from cells within 30 minutes to minimize uptake of corticosteroids by RBCs
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Plasma/Serum | Ambient | 8 hours |
| Refrigerate | 2 days | |
| Frozen | 90 days |
- Thaw samples only once
Test Components
Baseline Cortisol (ACTHSTB), 30 min Cortisol (ACTHST2), and 1 hour Cortisol (ACTHST3)
Test Information
Test orders a baseline cortisol plus two post-ACTH cortisols at 30 and 60 minutes. An alternative Low Dose (1 ug) ACTH Stimulation Test is also employed by some members of the Endocrinology Department. This requires saline dilution of a 250 ug dose as a 1 ug dosage form is not yet commercially available. Some argue that this dosing level is more physiologic and provides a better indication of adrenal reserve. For this protocol, a 30-minute specimen is typically obtained following injection. A normal response with this protocol is any cortisol ≥ 18 ug/dL.
The drug asfotase alfa (STRENSIQ), a recombinant form of alkaline phosphatase, is expected to interfere with in vitro diagnostic assays utilizing an alkaline phosphatase detection system. Test samples from patients taking asfotase alfa with a non-alkaline phosphatase methodology.
Interferences
Fluorescein will interfere; blood should not be drawn for 48 hours following fluorescein angiography for diabetic retinopathy.
Human Anti-Murine Antibodies (HAMA) may develop leading to test interference in patients receiving murine based chemotherapy agents or tumor-imaging studies.
For Tosoh AIA immunoassay method performed at Diagnostic and Treatment Center lab, the drug asfotase alfa (Strensiq), used for the treatment of patients with perinatal/infantile- and juvenile-onset hypophosphatasia (HPP), causes falsely decreased test results. Test results from patients treated with asfotase alfa should be interpreted with respect to the clinical picture of the patient. Recommend sending test to Marshfield Center lab for analysis by an alternate method.
Reference Range Information
| Performing Location | Reference Range |
|---|---|
| All Performing Sites | Standard 250 ug ACTH dose: Normal if cortisol ≥ 20 ug/dL at 30 or 60 min post dose draw. Alternate Low 1 ug ACTH dose: Normal if cortisol ≥ 18 ug/dL at 30 min post dose draw. |
Marshfield Labs Performing Department
Marshfield Labs Chemistry
Performing Information
| Performing Location | Day(s) Test Performed | Analytical Time | Methodology/Instrumentation |
|---|---|---|---|
| Marshfield | Monday through Sunday | Less than 2 hours | Beckman Coulter DXI |
CPT Codes
| CPT | Modifier (if needed) |
Quantity | Description | Comments |
|---|---|---|---|---|
| 80400 | ACTH Stim Panel | |||
| 82533 | Cortisol, total |
Outreach CPT Codes
| CPT | Modifier (if needed) |
Quantity | Description | Comments |
|---|---|---|---|---|
| 80400 | ACTH Stim Panel | |||
| 82533 | Cortisol, total |
Ordering Applications
| Ordering Application | Description |
|---|---|
| Cerner | ACTH Stim, 30 and 60 Min Cort |
| Cerner Powerchart | Ordered as Careset ACTH Stim, 30 and 60 Min Cort |