ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2)
CPT4 code
Name of the Procedure:
ACTH Stimulation Panel
Common Names: Adrenocorticotropic Hormone Stimulation Test, Cosyntropin Stimulation Test
Summary
The ACTH Stimulation Panel is a diagnostic test used to assess adrenal gland function. It involves measuring cortisol levels before and after an injection of synthetic ACTH (cosyntropin) to evaluate the adrenal glands' response and diagnose conditions like adrenal insufficiency.
Purpose
This procedure is designed to diagnose adrenal insufficiency, a condition where the adrenal glands do not produce sufficient amounts of cortisol. The goal is to determine how well the adrenal glands are functioning by evaluating their response to synthetic ACTH.
Indications
- Symptoms of adrenal insufficiency such as fatigue, muscle weakness, weight loss, low blood pressure, and darkening of the skin.
- Addison's disease suspicion.
- Monitoring adrenal function in patients with known adrenal gland disorders.
- Evaluating unexplained hypotension or electrolyte imbalances.
Preparation
- The patient may be instructed to fast (not eat or drink anything except water) starting at midnight before the test.
- Certain medications, especially corticosteroids, might need to be adjusted or withheld, as they can affect test results.
- Patients should notify their healthcare provider about all medications and supplements they are taking.
Procedure Description
- Baseline Measurement: A baseline blood sample is taken to measure initial cortisol levels.
- ACTH Injection: Synthetic ACTH (cosyntropin) is injected, usually into a vein.
- Follow-up Measurements: Blood samples are taken at specific intervals, typically 30 and 60 minutes after the injection, to measure cortisol levels.
- Analysis: The cortisol levels are analyzed to determine the adrenal glands' response to ACTH.
Duration
The procedure typically takes about 1 to 1.5 hours in total.
Setting
The test is performed in a hospital, outpatient clinic, or specialized diagnostic center.
Personnel
- Lab technician or nurse: Draws blood samples and administers the ACTH injection.
- Endocrinologist or primary care physician: Orders and interprets the test results.
Risks and Complications
- Common Risks: Brief pain or bruising at the injection site.
- Rare Risks: Allergic reaction to synthetic ACTH (cosyntropin).
Benefits
- Diagnostic Clarity: Helps diagnose adrenal insufficiency and other adrenal gland disorders.
- Guides Treatment: Assists in tailoring appropriate treatment plans based on adrenal function.
Recovery
- Immediate Care: The patient can usually resume normal activities immediately after the test.
- Follow-Up: Patients should follow up with their healthcare provider to discuss test results and next steps.
Alternatives
- Urine Cortisol Tests: Measuring cortisol levels in 24-hour urine collection.
- Salivary Cortisol Tests: Measuring cortisol levels in multiple saliva samples.
- Imaging Studies: CT scan or MRI to visualize the adrenal glands.
Pros and Cons of Alternatives: Urine and salivary tests are less invasive but might not be as comprehensive; imaging studies provide structural information but do not directly assess hormonal function.
Patient Experience
- During the Procedure: Patients might feel a slight sting from the blood draw and injection.
- After the Procedure: Generally, minimal discomfort; any pain at the injection site is usually short-lived.
- Pain Management: Not typically necessary, but over-the-counter pain relievers can be used if discomfort persists.