Injection, cosyntropin, 0.25 mg
HCPCS code
Name of the Procedure:
Injection of Cosyntropin
Common name(s): ACTH Stimulation Test Injection
Technical or medical term: Injection, Cosyntropin, 0.25 mg (HCPCS Code: J0834)
Summary
A cosyntropin injection is a diagnostic procedure used to assess adrenal gland function. Cosyntropin is a synthetic form of adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to produce cortisol. This injection helps determine if the adrenal glands are responding properly to ACTH.
Purpose
The primary purpose of the cosyntropin injection is to diagnose adrenal insufficiency, such as Addison's disease or secondary adrenal insufficiency. The goal is to evaluate adrenal function and ensure the proper production of cortisol, a vital hormone for stress response, metabolism, and immune function.
Indications
- Unexplained fatigue or weakness
- Low blood pressure
- Unintended weight loss
- Hyperpigmentation of the skin
- Suspected adrenal insufficiency or insufficient adrenal hormone production
- Monitoring the effectiveness of corticosteroid therapy
Preparation
- Patients may be asked to fast for 8 hours before the procedure.
- Certain medications might need to be adjusted or paused; the healthcare provider will give specific instructions.
- Blood tests may be required beforehand to measure baseline hormone levels.
Procedure Description
- Preparation: The patient will sit or lie down comfortably.
- Baseline Measurement: A blood sample is taken to measure the baseline cortisol level.
- Injection: Cosyntropin (0.25 mg) is injected intramuscularly or intravenously.
- Post-Injection Blood Draws: Additional blood samples are taken at timed intervals, typically at 30 minutes and 60 minutes after the injection, to measure cortisol levels.
- Analysis: The cortisol levels are compared to baseline to assess the adrenal gland's response.
Tools: Syringe, needle, blood collection tubes, and cosyntropin.
Anesthesia/Sedation: Not applicable; the procedure does not require anesthesia or sedation.
Duration
The entire procedure typically takes about 1 to 1.5 hours.
Setting
The procedure is usually performed in a hospital, outpatient clinic, or specialized endocrinology lab.
Personnel
- Healthcare provider (e.g., endocrinologist or nurse practitioner)
- Nurse or phlebotomist for blood sample collection
- Lab technician for hormone level analysis
Risks and Complications
- Common: Temporary discomfort or pain at the injection site.
- Rare: Allergic reaction to cosyntropin, infection or bleeding at the injection site.
- Managing complications: Medical staff is trained to manage any adverse reactions immediately.
Benefits
- Accurate assessment of adrenal function
- Prompt diagnosis of adrenal insufficiency
- Helps in directing appropriate treatment plans
- Results are typically available within a few days
Recovery
- Minimal post-procedure care is required.
- Patients can resume normal activities immediately.
- Follow-up appointments might be scheduled to discuss results and next steps.
Alternatives
- ACTH blood test (measures hormone levels without stimulation)
- Insulin-induced hypoglycemia test
- 24-hour urinary free cortisol test
Pros and Cons:
- Pros: Cosyntropin injection provides a direct assessment of adrenal response, which can yield more accurate results compared to some alternatives.
- Cons: Alternatives like blood tests or urine tests may be less invasive and more convenient but may not provide as detailed an assessment.
Patient Experience
During the procedure, patients will experience a brief needle stick for the injection and blood draws. Discomfort is generally minimal. After the procedure, there might be mild soreness at the injection site, which can be managed with over-the-counter pain relief if needed.