Collect

Specimen Type:
Preferred: Lithium Heparin Plasma
Acceptable: Serum
Container/Tube: Light-green top (lithium heparin gel)
Specimen Volume: 1 mL

Collection Instructions:
This test is ideally performed in the morning before 8 to 9 a.m.
1. Order and draw a regular AM Cortisol (SQ CORTAM, EPIC LAB2382) for a baseline Cortisol result.
2. Dose the patient with Cosyntropin (250 mcg) given by IV.
3. Order the Cortisol, Post Stimulation test and draw at 30 to 60 minutes post dose.
4. Indicate time of both draws.
 

Special Instructions

Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.

Storage/Transport Temperature

Refrigerated/Ambient <24 hours/Frozen OK

Stability (from collection to initiation)

24 hours at RT 20‑25 °C
4 days at Refrig 2‑8 °C
12 months Frozen (-15)‑(-25)°C
Freeze only once.
 

Epic EAP

LAB2386

Performed

Monday through Sunday

Reported

Stat: 1 hour
Routine: 4 hours

CPT Codes

82533

Ordering Recommendations

This test is for Ambulatory Use- details in Collection Section below.

For Inpatient use-

If a complete Cortisol Stimulation Test is requested for an inpatient, use Epic Order Set:

O33328 CORTISOL STIMULATION TEST - COSYNTROPIN (FD/DM/SC/MHM)

This Order set includes: Cortisol Stimulation Baseline Test, One Consyntropin Injection, a Cortisol Stim 30 Min Test, and a Cortisol Stim 60 Min Test.

Performing Lab

Meriter Laboratories

Reference Interval

Result Interpretation:

Basal (before 250 mcg dose) Cortisol:
<5 ug/dL: Best predicted hypothalamic-pituitary-adrenal insufficiency (HPAI)
5 to 13 ug/dL: Diagnostically Indeterminate
>13 ug/dL: Best predicted normal hypothalamic-pituitary-adrenal axis
 

Cortisol at 30-60 minutes:

<15 ug/dL: Highly predictive of hypothalamic-pituitary-adrenal insufficiency (HPAI) ·
>15 ug/dL: Best predicted normal hypothalamic-pituitary-adrenal function

Note: Interpretation in critical illness is not well established. This test may have relatively low sensitivity for secondary adrenal insufficiency, especially if it is partial or of recent onset. While basal cortisol may be low in suppression by chronic glucocorticoid treatment, response to ACTH can still be normal. How long this response lasts is controversial and probably very individual.

References:
Javorsky B, Carroll T, Algeciras-Schimnich A, Singh R, Colon-Franco J, Findling J: New cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation Using Specific cortisol Assays.  Journal of the Endocrine Society , Volume 5 Issue 4, April 2021

Interference Claim

Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.

Pregnancy, contraceptives and estrogen therapy give rise to elevated cortisol concentrations.

In samples from patients who have been treated with prednisolone, 6‑α‑Methylprednisolone or prednisone, falsely elevated concentrations of cortisol may be determined.

During metyrapon tests, 11‑deoxycortisol levels are elevated. Falsely elevated cortisol values may be determined due to cross reactions.

Patients suffering from 21‑hydroxylase deficiency exhibit elevated 21‑deoxycortisol levels and this can also give rise to falsely elevated cortisol results.

The time of sample collection must be taken into account when interpreting results due to the cortisol secretion circadian rhythm. Severe stress can also give rise to elevated cortisol levels.
 

Methodology

Electrochemiluminescence Immunoassay (ECLIA)

Collection

Collect

Specimen Type:
Preferred: Lithium Heparin Plasma
Acceptable: Serum
Container/Tube: Light-green top (lithium heparin gel)
Specimen Volume: 1 mL

Collection Instructions:
This test is ideally performed in the morning before 8 to 9 a.m.
1. Order and draw a regular AM Cortisol (SQ CORTAM, EPIC LAB2382) for a baseline Cortisol result.
2. Dose the patient with Cosyntropin (250 mcg) given by IV.
3. Order the Cortisol, Post Stimulation test and draw at 30 to 60 minutes post dose.
4. Indicate time of both draws.
 

Special Instructions

Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.

Storage/Transport Temperature

Refrigerated/Ambient <24 hours/Frozen OK

Stability (from collection to initiation)

24 hours at RT 20‑25 °C
4 days at Refrig 2‑8 °C
12 months Frozen (-15)‑(-25)°C
Freeze only once.
 
Ordering

Epic EAP

LAB2386

Performed

Monday through Sunday

Reported

Stat: 1 hour
Routine: 4 hours

CPT Codes

82533

Ordering Recommendations

This test is for Ambulatory Use- details in Collection Section below.

For Inpatient use-

If a complete Cortisol Stimulation Test is requested for an inpatient, use Epic Order Set:

O33328 CORTISOL STIMULATION TEST - COSYNTROPIN (FD/DM/SC/MHM)

This Order set includes: Cortisol Stimulation Baseline Test, One Consyntropin Injection, a Cortisol Stim 30 Min Test, and a Cortisol Stim 60 Min Test.

Performing Lab

Meriter Laboratories
Clinical Information

Reference Interval

Result Interpretation:

Basal (before 250 mcg dose) Cortisol:
<5 ug/dL: Best predicted hypothalamic-pituitary-adrenal insufficiency (HPAI)
5 to 13 ug/dL: Diagnostically Indeterminate
>13 ug/dL: Best predicted normal hypothalamic-pituitary-adrenal axis
 

Cortisol at 30-60 minutes:

<15 ug/dL: Highly predictive of hypothalamic-pituitary-adrenal insufficiency (HPAI) ·
>15 ug/dL: Best predicted normal hypothalamic-pituitary-adrenal function

Note: Interpretation in critical illness is not well established. This test may have relatively low sensitivity for secondary adrenal insufficiency, especially if it is partial or of recent onset. While basal cortisol may be low in suppression by chronic glucocorticoid treatment, response to ACTH can still be normal. How long this response lasts is controversial and probably very individual.

References:
Javorsky B, Carroll T, Algeciras-Schimnich A, Singh R, Colon-Franco J, Findling J: New cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation Using Specific cortisol Assays.  Journal of the Endocrine Society , Volume 5 Issue 4, April 2021

Interference Claim

Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.

Pregnancy, contraceptives and estrogen therapy give rise to elevated cortisol concentrations.

In samples from patients who have been treated with prednisolone, 6‑α‑Methylprednisolone or prednisone, falsely elevated concentrations of cortisol may be determined.

During metyrapon tests, 11‑deoxycortisol levels are elevated. Falsely elevated cortisol values may be determined due to cross reactions.

Patients suffering from 21‑hydroxylase deficiency exhibit elevated 21‑deoxycortisol levels and this can also give rise to falsely elevated cortisol results.

The time of sample collection must be taken into account when interpreting results due to the cortisol secretion circadian rhythm. Severe stress can also give rise to elevated cortisol levels.
 

Methodology

Electrochemiluminescence Immunoassay (ECLIA)

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