Dynamic Function test Version: 1

CC SOP Short Synacthen Test

Standard Operating Procedure Review date: 14/08/2009
0032 CC0032
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

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SHORT SYNACTHEN TEST

STANDARD OPERATING PROCEDURE

CC0032

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Page 1 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP Short Synacthen Test
Standard Operating Procedure Review date: 14/08/2009
0032 CC0032
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

Standard Short Synacthen test

Adrenal insufficiency leads to a reduction in the output of adrenal hormones i.e. glucocorticoids and/or
mineralocorticoids. There are two types of adrenal insufficiency:
1. Primary insufficiency - there is an inability of the adrenal glands to produce enough steroid
hormones (Addison's disease is the name given to the autoimmune cause of this insufficiency).
Glucocorticoid and often mineralocorticoid hormones are lost.
2. Secondary insufficiency - there is inadequate pituitary or hypothalamic stimulation of the adrenal
glands.

This test is performed for the investigation of primary adrenal insufficiency. There is no evidence to
support the use of this test in the management of steroid replacement or withdrawal.

Principle

Adrenal glucocorticoid secretion is controlled by adrenocorticotrophic hormone (ACTH) released by

the anterior pituitary. This test evaluates the ability of the adrenal cortex to produce cortisol after
stimulation by synthetic ACTH (tetracosactide; Synacthen®). It does not test the whole pituitary-
adrenal axis. The short test assesses the ability of the adrenal gland to respond to ACTH but is not
reliable within 2 weeks of pituitary surgery.

Side effects

There are rare reports of hypersensitivity reactions to ‘Synacthen’ particularly in children with history
of allergic disorders.

Preparation

There are no dietary restrictions for this test. This test should be performed in the morning as the
cortisol responses between the morning and late afternoon may differ by as much as 100 nmol/L at
30 min sample post Synacthen.

Test procedure

Adults: 250 microgram Synacthen (1 vial)

Children: 36 microgram/kg body weight up to a maximum of 250 micrograms

Time Test Sample Sample tube Give dose

volume after sample
0 min (9 am) Cort 2ml Plain tube (buff top) for adults and Li Synacthen
Heparin (orange tube) for paediatrics injection
30 min Cort 2ml Same as above
60 min Cort 2ml Same as above

Do not photocopy this document

Page 2 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP Short Synacthen Test
Standard Operating Procedure Review date: 14/08/2009
0032 CC0032
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

Interpretation

1. Adrenal insufficiency is excluded by an incremental rise in cortisol of > 200nmol/L and a 30

min value > 600 nmol/L.
2. The above definition only defines adrenal insufficiency. The definition of normality is
problematic since there is considerable variation in healthy individuals and a significant
overlap with patients who have adrenal insufficiency.
3. In ACTH deficiency the response to the short test may be normal or reduced.
4. The response to Synacthen is not affected by obesity.
5. There is no difference in cortisol response between iv & im administration.
6. Baseline and incremental cortisol values do NOT apply to women taking oral contraceptives or
to pregnant women.

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Page 3 of 3
Last printed: 14 August 2008