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23278 ACTH Stimulation, 30 and 60 Min Cortisols

ACTH Stimulation, 30 and 60 Min Cortisols
Test Code: ACTH Stim, 30 and 60 Min Cort
Synonyms/Keywords
​​​​​Cosyntrophin Stimulation Test
Adrenocorticol (ACTH) Stimulation Test
Cortrosyn Stimulation Test, Cortisol
Test Components

​Baseline Cortisol (ACTHSTB), 30 min Cortisol (ACTHST2), and 1 hour Cortisol (ACTHST3)​

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​ Serum or Plasma​Serum Separator Tube (SST)Red Top Tube (RTT),Lithium-heparin Plasma Separator Tube (PST), Sodium-heparin Green Top Tube (GTT) 0.5 mL​0.3 mL​0.255 mL​
Specimen Stability Information
Specimen Type Temperature Time
Serum/Plasma​ Ambient ​ 8 hours​
Refrigerate​ 7 days​
Serum​ Frozen​ >7 days​
Interference
​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.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Weston​ ​Monday through Friday ​Less than 2 hours​ ​Competitive Enzyme Immunoassay/Tosoh
Marshfield​ Monday through Sunday​ Less than 2 hours​
Competitive Immunoassay using Direct Chemiluminescent Technology/Siemens Centaur
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.​ 

ACTH (Cosyntrophin) One-Hour Stimulation Test

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. ​
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80400​ ​ ​ ACTH Stim Panel​ ​
82533​ ​ ​ Cortisol, total​ ​
Synonyms/Keywords
​​​​​Cosyntrophin Stimulation Test
Adrenocorticol (ACTH) Stimulation Test
Cortrosyn Stimulation Test, Cortisol
Test Components

​Baseline Cortisol (ACTHSTB), 30 min Cortisol (ACTHST2), and 1 hour Cortisol (ACTHST3)​

Ordering Applications
Ordering Application Description
​Cerner ​ACTH Stim, 30 and 60 Min Cort
​Cerner Powerchart
​Ordered as Careset
11 - 10 Capture.PNGACTH Stim, 30 and 60 Min Cort

If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
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​ Serum or Plasma​Serum Separator Tube (SST)Red Top Tube (RTT),Lithium-heparin Plasma Separator Tube (PST), Sodium-heparin Green Top Tube (GTT) 0.5 mL​0.3 mL​0.255 mL​
Specimen Stability Information
Specimen Type Temperature Time
Serum/Plasma​ Ambient ​ 8 hours​
Refrigerate​ 7 days​
Serum​ Frozen​ >7 days​
Interference
​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.
Test Components

​Baseline Cortisol (ACTHSTB), 30 min Cortisol (ACTHST2), and 1 hour Cortisol (ACTHST3)​

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. ​
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Weston​ ​Monday through Friday ​Less than 2 hours​ ​Competitive Enzyme Immunoassay/Tosoh
Marshfield​ Monday through Sunday​ Less than 2 hours​
Competitive Immunoassay using Direct Chemiluminescent Technology/Siemens Centaur
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80400​ ​ ​ ACTH Stim Panel​ ​
82533​ ​ ​ Cortisol, total​ ​
For most current information refer to the Marshfield Laboratory online reference manual.