From the Guidelines
The dose of cosyntropin for the ACTH stimulation test is 250 μg.
Rationale
- The high-dose (250-μg) ACTH stimulation test is recommended for the diagnosis of critical illness-related corticosteroid insufficiency (CIRCI) 1, 2, 3.
- The task force suggests using the high-dose rather than the low-dose ACTH test due to its easier practical modalities and comparable accuracy 3.
- A recent meta-analysis found that the high- and low-dose ACTH tests had similar diagnostic accuracy for secondary adrenal insufficiency, but the high-dose test is preferred due to its ease of use and safety 3.
- The high-dose ACTH test is considered superior to other existing diagnostic tests to establish the diagnosis of primary adrenal insufficiency, with peak cortisol levels below 18 μg/dl indicating adrenal insufficiency 4.
Key Points
- The high-dose ACTH stimulation test is the most popular diagnostic test for adrenal insufficiency.
- The low-dose ACTH test requires more preparation and has similar diagnostic accuracy to the high-dose test.
- The task force recommends using the high-dose ACTH test due to its ease of use and comparable accuracy.
From the FDA Drug Label
For adults, the recommended dose is 0.25 mg to be administered by intravenous or intramuscular injection. For pediatric patients, the recommended dose to be administered by intravenous or intramuscular injection is o 0.125 mg for patients birth to less than 2 years of age o 0. 25 mg for patients 2 to 17 years of age
The dose of cosyntropin for the ACTH stimulation test is:
- 0.25 mg for adults
- 0.125 mg for pediatric patients birth to less than 2 years of age
- 0.25 mg for pediatric patients 2 to 17 years of age 5
From the Research
Cosyntropin Dose for ACTH Stimulation Test
The dose of cosyntropin for the ACTH stimulation test can vary, with different studies suggesting different doses.
- A study published in 2022 6 compared cortisol response to a weight-adapted cosyntropin dose vs. a fixed low dose (1 µg) and a more physiologically fixed dose (10 µg) in individuals with obesity.
- Another study published in 2021 7 discussed the use of 1-μg and 250-μg doses of cosyntropin in the diagnosis of adrenal insufficiency.
- A systematic review and meta-analysis published in 2016 8 found that high- (250 mcg) and low- (1 mcg) dose ACTH stimulation tests had similar diagnostic accuracy in adults and children.
- A prospective, randomized pilot study published in 2017 9 compared 1 μg IV low dose cosyntropin test, 25 μg IM medium dose cosyntropin test, and 250 μg IM standard dose cosyntropin test to evaluate secondary adrenal insufficiency.
- A study published in 2018 10 used a 1 μg/kg dose of cosyntropin for low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism.
Commonly Used Doses
Some commonly used doses of cosyntropin for the ACTH stimulation test include:
- 1 μg 6, 7, 8, 9
- 250 μg 7, 8, 9
- 25 μg 9
- 0.2 μg/kg (weight-adapted dose) 6
- 1 μg/kg (in dogs) 10
- 5 μg/kg (in dogs) 10
Diagnostic Accuracy
The diagnostic accuracy of the ACTH stimulation test can depend on the dose of cosyntropin used, as well as the population being tested 8, 9.