ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)
CPT4 code
Name of the Procedure:
ACTH Stimulation Panel for 21 Hydroxylase Deficiency
Common Name(s): ACTH stimulation test, Cosyntropin stimulation test
Technical/M edical Term: Adrenocorticotropic hormone (ACTH) stimulation panel
Summary
The ACTH stimulation panel is a diagnostic test used to evaluate the functioning of the adrenal glands by measuring cortisol and 17-hydroxyprogesterone levels before and after administration of synthetic ACTH.
Purpose
Medical Condition: 21 Hydroxylase Deficiency
Goals: To assess adrenal gland function and diagnose conditions such as congenital adrenal hyperplasia (CAH) due to 21 hydroxylase deficiency.
Indications
- Symptoms of adrenal insufficiency like fatigue, muscle weakness, and salt craving.
- Ambiguous genitalia or other signs of CAH in newborns.
- Unexplained low blood pressure or dehydration.
- Screening in patients with a family history of 21 hydroxylase deficiency.
Preparation
- Patients may be instructed to fast for a certain period before the test.
- Medications affecting cortisol levels should be adjusted as directed by the healthcare provider.
- A preliminary blood draw may be required to establish baseline levels.
Procedure Description
- Baseline Blood Draw: A blood sample is taken to measure initial cortisol (82533) and 17-hydroxyprogesterone (83498) levels.
- Administration of ACTH: Synthetic ACTH (cosyntropin) is administered via injection.
- Post-ACTH Blood Draws: Additional blood samples are taken at specified intervals (usually 30 and 60 minutes after administration) to measure the levels of cortisol and 17-hydroxyprogesterone again.
Tools and Equipment: Needles, syringes, synthetic ACTH (cosyntropin), blood collection tubes.
Anesthesia/Sedation: Not typically required.
Duration
The entire procedure typically takes about 1-2 hours.
Setting
The procedure is usually performed in an outpatient clinic or hospital laboratory.
Personnel
- Trained nurses or phlebotomists for blood draws.
- A healthcare provider such as an endocrinologist or pediatrician to supervise the test.
Risks and Complications
- Minor risks include pain or bruising at the injection site.
- Rarely, allergic reactions to synthetic ACTH.
Benefits
- Accurate diagnosis of 21 hydroxylase deficiency or other adrenal disorders.
- Guidance for appropriate treatment and management of diagnosed conditions.
Recovery
- Post-procedure care is minimal and typically involves monitoring for any immediate reactions to the injection.
- Patients can typically resume normal activities shortly after the procedure.
- Follow-up appointments may be scheduled to discuss test results and further treatment plans.
Alternatives
- Other diagnostic tests, such as genetic testing or different hormonal assays.
- Pros: Genetic testing is non-invasive and can directly indicate CAH.
- Cons: ACTH stimulation test provides functional information about adrenal performance not available from genetic tests.
Patient Experience
- Patients may feel a slight discomfort from needle sticks for blood draws and the injection.
- Pain management measures include local anesthetics or cold sprays to numb the area.
- Overall, the procedure is well-tolerated and low-risk.