1 Hour (Rapid) ACTH Stimulation (Cosyntropin or Synacthen) Test
Procedure
Baseline sample for serum cortisol.
250 μg of cosyntropin is given intramuscularly or intravenously.
Additional samples for serum cortisol: 30 and 60 minutes after injection.
Interpretation
A peak cortisol concentration of 18 to 20 μg/dL or greater is a normal response.
The expected change in cortisol concentration is 7 to 10 μg/dL (the delta cortisol).
Overnight Low-Dose Dexamethasone Suppression Test
Procedure
1 mg dexamethasone is given orally between 2200 and 2400.
Blood for serum cortisol: at 0800 hours the next morning.
Interpretation
In normal subjects, serum cortisol concentration is suppressed to 2 μg/dL or less.
In most patients with Cushing syndrome, 0800 hours cortisol concentrations are usually
10 μg/dL or greater.
Insulin-Induced Hypoglycemia Stimulation Test [Insulin Tolerance Test (ITT)]
Procedure
Overnight fast with the patient at bed rest.
An indwelling intravenous line is inserted.
Baseline samples for glucose, GH, and cortisol after a 30-minute rest period.
Regular insulin, 0.1 to 0.15 units/kg body weight, is injected intravenously.
Samples are then obtained at +10, +20, +40, and +60 minutes for glucose, GH, and
cortisol. (Optional time points are +30, +75, +90, and +120 minutes).
To be confident that adequate stress has been applied, the patient must become
symptomatic (exhibit sweating or tremor), or the glucose concentration must fall to below
40 to 45 mg/dL.
Interpretation
Serum cortisol concentration should increase to a peak value of 18 to 20 μg/dL or greater.
Serum GH concentration should rise to a peak value of 7 to 10 ng/mL or greater.
Glucose Suppression of Growth Hormone Test
Procedure
Overnight fast with the patient maintained at bed rest.
Baseline blood specimen is collected for GH and glucose measurement.
A solution of 75 g of glucose is given orally.
Specimens for glucose and GH are collected 30, 60, 90, and 120 minutes later.
Interpretation
Serum GH concentrations in normal individuals fall to less than 1 to 2 μg/L.
Subjects with acromegaly fail to show this suppression and sometimes show a
paradoxical increase in GH concentration.
