ACTH stimulation test

In this video, we will review the ACTH (cortrosyn) stimulation test in both the diagnosis of adrenal insufficiency and nonclassic congenital adrenal hyperplasia. Recent changes to the cutoff limits of the cortisol assay and optimal testing conditions will be covered.
The ACTH (cortrosyn) stimulation test is performed to determine if the adrenal glands can respond appropriately to exogenous ACTH.
In patients with primary adrenal insufficiency, serum cortisol is low in the setting of elevated adrenocorticotropic hormone levels. Furthermore, the 24-hour urinary cortisol excretion is low in patients with adrenal insufficiency.
A helpful rule of thumb is that in symptomatic patients, an 8 am serum ACTH concentration greater than 500 pg/mL and a concomitant serum cortisol concentration less than 5 μg/dL is diagnostic of primary adrenal insufficiency. In this setting, an ACTH stimulation test is unnecessary.
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