, Volume 57, Issue 1, pp 46–50 | Cite as

Performance of low-dose cosyntropin stimulation test handled via plastic tube

  • Leonard SaieghEmail author
  • Asala Abu-Ahmad
  • Mohammad Sheikh-Ahmad
  • Maria Reut
  • Limor Chen-Konak
  • Nizar Jiries
  • Carmela Shechner
Endocrine Methods and Techniques



Studies on 1 μg low-dose test showed that among 1 μg cosyntropin samples pushed through long IV plastic tubing, some adrenocorticotropic hormone dosage was not recovered, and in healthy volunteers it provided subnormal cortisol responses. The aim of the current study is to assess whether there is any loss in adrenocorticotropic hormone 1–24 concentration when pushed through a short plastic tube, and to assess serum and salivary cortisol responses in low-dose test among healthy volunteers, using a similar short plastic tube vs. direct intravenous consyntropin injection.


We evaluated in vitro if adrenocorticotropic hormone was absorbed in a 2.5 cm plastic tube by measuring adrenocorticotropic hormone 1–24 concentration in a 1 μg/ml adrenocorticotropic hormone aliquot solution before and after being flushed through the plastic tube. For the in vivo study, we recruited 20 healthy adult volunteers. Each subject underwent low-dose test via 2.5 cm plastic tube via plastic tube and via direct intravenous injection by a metal syringe via direct intravenous injection, and cortisol responses were determined.


Mean adrenocorticotropic hormone 1–24 concentration did not differ significantly when flushed via plastic tube or measured in the aliquot solution (P = 0.25). In vivo, mean 30-min serum cortisol concentrations were 20.47 ± 2.87 and 21.62 ± 3.89 μg/dl in via plastic tube and in via direct intravenous injection tests, respectively, and did not show a significant difference (P = 0.16).


In low-dose test, using a 2.5 cm plastic tube ensures completeness of the intravenous adrenocorticotropic hormone injection dosage and provides equivalent cortisol responses.


Cosyntropin Hypoadrenalism Cortisol ACTH 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    J.B. Wood, A.W. Frankland, V.H. James, J. Landon, A rapid test of adrenocortical function. Lancet. 30, 243–245 (1965)CrossRefGoogle Scholar
  2. 2.
    B. Ambrosi, L. Barbetta, T. Re, E. Passini, G. Faglia, The one microgram adrenocorticotropin test in the assessment of hypothalamic-pituitary-adrenal function. Eur. J. Endocrinol. 139, 575–579 (1998)CrossRefGoogle Scholar
  3. 3.
    G. Dickstein, C. Shechner, W.E. Nicholson, I. Rosner, Z. Shen-Orr, F. Adawi, M. Lahav, Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J. Clin. Endocrinol. Metab. 72, 773–778 (1991)CrossRefGoogle Scholar
  4. 4.
    K. Tordjman, A. Jaffe, N. Grazas, C. Apter, N.J. Stern, The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J. Clin. Endocrinol. Metab. 80, 1301–1305 (1995)PubMedGoogle Scholar
  5. 5.
    S. Rasmuson, T. Olsson, E. Hagg, A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin. Endocrinol. 44, 151–156 (1996)CrossRefGoogle Scholar
  6. 6.
    T.A. Abdu, T.A. Elhadd, R. Neary, R.N. Clayton, Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J. Clin. Endocrinol. Metab. 84, 838–843 (1999)PubMedGoogle Scholar
  7. 7.
    R. Kazlauskaite, A.T. Evans, C.V. Villabona, T.A. Abdu, B. Ambrosi, A.B. Atkinson, C.H. Choi, R.N. Clayton, C.H. Courtney, E.N. Gonc, M. Maghnie, S.R. Rose, S.G. Soule, K. Tordjman, Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis. J. Clin. Endocrinol. Metab. 93, 4245–4253 (2008)CrossRefGoogle Scholar
  8. 8.
    A. Beishuizen, J.H. van Lijf, J.F. Lekkerkerker, I. Vermes, The low dose (1 microg) ACTH stimulation test for assessment of the hypothalamo-pituitary-adrenal axis. Neth. J. Med. 56, 91–99 (2000)CrossRefGoogle Scholar
  9. 9.
    G. Dickstein, L. Saiegh, Low-dose and high-dose adrenocorticotropin testing: indications and shortcomings. Curr. Opin. Endocrinol. Diabetes. Obes. 15, 244–249 (2008)CrossRefGoogle Scholar
  10. 10.
    G. Reimondo, S. Bovio, B. Allasino, M. Terzolo, A. Angeli, Secondary hypoadrenalism. Pituitary. 11, 147–154 (2008)CrossRefGoogle Scholar
  11. 11.
    Y.J. Park, K.S. Park, J.H. Kim, C.S. Shin, S.Y. Kim, H.K. Lee, Reproducibility of the cortisol response to stimulation with the low dose (1 microg) of ACTH. Clin. Endocrinol. 51, 153–158 (1999)CrossRefGoogle Scholar
  12. 12.
    J.G. Gonzalez-Gonzalez, N.E. De la Garza-Hernandez, L.G. Mancillas-Adame, J. Montes-Villarreal, J.Z. Villarreal-Perez, A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency. J. Endocrinol. 159, 275–280 (1998)CrossRefGoogle Scholar
  13. 13.
    H. Murphy, J. Livesey, E.A. Espiner, R.A. Donald, The low dose ACTH test--a further word of caution. J. Clin. Endocrinol. Metab. 83, 712–713 (1998)CrossRefGoogle Scholar
  14. 14.
    M. Wade, S. Baid, K. Calis, H. Raff, N. Sinaii, L. Nieman, Technical details influence the diagnostic accuracy of the 1 microg ACTH stimulation test. Eur. J. Endocrinol. 162, 109–113 (2010)CrossRefGoogle Scholar
  15. 15.
    L.K. Nieman, Dynamic evaluation of adrenal hypofunction. J. Endocrinol. Invest. 26, 74–82 (2003)PubMedGoogle Scholar
  16. 16.
    M.G. Burt, B.L. Mangelsdorf, A. Rogers, J.T. Ho, J.G. Lewis, W.J. Inder, M.P. Doogue, Free and total plasma cortisol measured by immunoassay and mass spectrometry following ACTH1–24 stimulation in the assessment of pituitary patients. J. Clin. Endocrinol. Metab. 98, 1883–1890 (2013)CrossRefGoogle Scholar
  17. 17.
    L.C. Smans, P.M. Zelissen, Is diagnosis and subclassification of adrenal insufficiency as easy as it looks? Front. Horm. Res. 46, 146–158 (2016)CrossRefGoogle Scholar
  18. 18.
    Y. Marcus-Perlman, K. Tordjman, Y. Greenman, R. Limor, G. Shenkerman, E. Osher, N. Stern, Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test. Clin. Endocrinol. 64, 215–258 (2006)CrossRefGoogle Scholar
  19. 19.
    I. Perogamvros, L.J. Owen, B.G. Keevil, G. Brabant, P.J. Trainer, Measurement of salivary cortisol with liquid chromatography-tandem mass spectrometry in patients undergoing dynamic endocrine testing. Clin. Endocrinol. 72, 17–21 (2010)CrossRefGoogle Scholar
  20. 20.
    W.J. Inder, G. Dimeski, A. Russell, Measurement of salivary cortisol in 2012 - laboratory techniques and clinical indications. Clin. Endocrinol. 77, 645–651 (2012)CrossRefGoogle Scholar
  21. 21.
    M.P. Cornes, H.L. Ashby, Y. Khalid, H.N. Buch, C. Ford, R. Gama, Salivary cortisol and cortisone responses to tetracosactrin (synacthen). Ann. Clin. Biochem. 52, 606–610 (2015)CrossRefGoogle Scholar
  22. 22.
    J. Cartaya, M. Misra, The low-dose ACTH stimulation test: is 30 minutes long enough? Endocr. Pract. 21, 508–513 (2015)CrossRefGoogle Scholar
  23. 23.
    A. Salcido-Montenegro, K.E. Carlos-Reyna, H.E. Tamez-Pérez, J.G. González-González, Low-dose ACTH stimulation test: dose, sampling time, and technical issues. Endocr. Pract. 21, 1079 (2015)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Leonard Saiegh
    • 1
    Email author
  • Asala Abu-Ahmad
    • 2
  • Mohammad Sheikh-Ahmad
    • 1
  • Maria Reut
    • 1
  • Limor Chen-Konak
    • 1
  • Nizar Jiries
    • 2
  • Carmela Shechner
    • 1
  1. 1.Department of EndocrinologyBnai-Zion Medical CenterHaifaIsrael
  2. 2.Department of Internal Medicine BBnai-Zion Medical CenterHaifaIsrael

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