Short Synacthen Stimulation Test



Endocrine Dynamic Function Tests

SHORT SYNACTHEN STIMULATION TEST

Indications:

Diagnosis of Adrenal Insufficiency

Useful screen for the Cortisol sector in suspected Hypopituitarism.

Contra-indications:

1) History of hypersensitivity to ACTH, Synacthen or Synacthen Depot.

2) Use with caution if hypersensitivity to other drugs or in patients with allergic disorders.

Precautions:

The patient must not be on steroids during the test. However, if the patient is unwell and Adrenal Insufficiency is strongly suspected, treatment should not be withheld. Treat with dexamethasone (0.25 mg daily). Other steroids may interfere with the laboratory measurement of cortisol.

Procedure:

1. No particular patient preparation is required. There is no requirement for fasting. Ideally, the test is best performed in the morning.

2. Take blood for basal cortisol estimation (single SST) - may be held on the ward until all samples have been collected.

3. Inject Synacthen 250 mcgs i.m.

4. Take further blood samples at 30 and 60 mins post injection (single SST on each occasion).

5. Send all three samples to the laboratory together with completed proforma

Guidelines to Interpretation:

Ideally, serum cortisol should rise from a basal level > 200 nmol/L, by > 200 nmol/l to a peak > 550 nmol/l.

Failure to respond suggests either primary or secondary adrenal failure. A depot synacthen test may be indicated to confirm primary adrenal failure

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Please note that these guidelines apply to adults only; for children please contact Dr Amanda Billson, Consultant Paediatrician

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