cosyntropin (ACTH, Cortrosyn) stimulation test (delta cortisol test)

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  • unnecessary when when AM serum cortisole is < 3 ug/dL



  • a normal response is a stimulated cortisol of > 18-20 ug/dL
  • this test detects both primary & secondary adrenal failure except within a few weeks of onset of pituitary dysfunction
  • in an ICU setting, diagnosis of adrenal insufficiency[5]
    • ruled in
      • baseline serum cortisol < 10 ug/dL
      • increase of < 9 ug/dL after adrenal stimulation
    • ruled out
      • stimulated cortisol to > 44 ug/dL
      • increase of serum cortisol > 17 ug/dL after stimulation
    • other values indeterminant
Chronic low-dose steroids suppressive response to some degree
agent baseline cortisol cortisol 60 min post ACTH
placebo 12.6 ug/dL 28.6 ug/dL
budesonide 3 mg QD 12.4 ug/dL 23.4 ug/dL
budesonide 9 mg QD 10.4 ug/dL 19.8 ug/dL
prednisolone 7.5 mg QD 9.1 ug//dL 18.5 ug/dL
  • peak serum aldosterone levels < 4 ng/mL suggest primary adrenal insufficiency


More general terms

Additional terms


  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995,l pg 474
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 654
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  4. Kirwan JR et al, The effect of therapeutic glucocorticoids on the adrenal response in a randomized controlled trial in patients with rheumatoid arthritis. Arthritis Rheum 2006; 54:1415 PMID:
  5. 5.0 5.1 Annane D et al, Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med 2006, 174:1319 PMID:
    Meyer NJ and Hall JB Relative adrenal insufficiency in the ICU: Can we at least make the diagnosis? Am J Respir Crit Care Med 2006, 174:1282 PMID: