ACTH Stimulation, 2 Time Points




Test Mnemonic

ACTHS2

CPT Codes

  • 80400 - QTY (1)

Includes

  • Baseline Cortisol
  • Cortisol post stimulation

Performing Laboratory

Cleveland Clinic Laboratories


Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
1 mLPlasmaLithium heparin PST (Lt. Green) RefrigeratedCollect a baseline specimen, then collect a specimen 60 minutes after intravenous/intramuscular administration of cortrosyn (cosyntropin).

Alternate Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
1 mLSerumSST (Gold) RefrigeratedCollect a baseline specimen, then collect a specimen 60 minutes after intravenous/intramuscular administration of cortrosyn (cosyntropin).
1 mLPlasmaEDTA (Lavender)Centrifuge, aliquot and refrigerate.RefrigeratedCollect a baseline specimen, then collect a specimen 60 minutes after intravenous/intramuscular administration of cortrosyn (cosyntropin).

Minimum Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
0.3 mL    Collect a baseline specimen, then collect a specimen 60 minutes after intravenous/intramuscular administration of cortrosyn (cosyntropin).

Stability

Environmental Condition Description
Ambient24 hours
Refrigerated4 days
Frozen12 months

Days Performed

Sun - Sat

Turnaround Time

24 hours

Methodology

Name Description
Electro Chemiluminescence Immunoassay (ECLIA) 

Reference Range

Cortisol, Basal
Sex Age From Age To Type Range Range Unit
       NormalMorning hours 6:00 to 10:00 am: 4.8-19.5ug/dL
       NormalAfternoon hours 4:00 to 8:00 pm: 2.5-11.9ug/dL
Interpretation
Sex Age From Age To Type Range Range Unit
       After cortrosyn stimulation, a peak cortisol response greater than 12.6 µg/dL may indicate appropriate cortisol secretion. This result should be interpreted within the clinical context and other test results. G.A.Kline, et al. Clinical Implicatoions for Biochemical Diagnostic Thresholds of Adrenal Sufficiency Using a Highly Specific Cortisol Immunoassay. 2017 Clin. Biochem. 50:475-480. 

Special Info

Patients taking a biotin dose of up to 5 mg/day should refrain from taking biotin for 4 hours prior to sample collection. Patients taking a biotin dose of 5 to 10 mg/day should refrain from taking biotin for 8 hours prior to sample collection. Patients taking a biotin dose > 10 mg/day should consult with their physician or the laboratory prior to having a sample taken. Clinicians should consider biotin interference as a source of error, when clinically suspicious of the laboratory result.

Clinical Info

Diagnosis of adrenal insufficiency.

Clinical Limitation

During metyrapon tests, 11 deoxycortisol levels are elevated. Falsely elevated cortisol values may be determined due to cross reactions. In samples from patients who have been treated with prednisolone, 6-alpha-Methylprednisolone or prednisone, falsely elevated concentrations of cortisol may be determined.