WASHINGTON, D.C. – Today new guidelines released by the Endocrine Society (ES) encourage modification of the standard high-dose ACTH stimulation test with measurement of serum cortisol levels q1minute for the entire 60-minute duration of the test.
“Many hospitals have order sets that recommend checking a cortisol at baseline, then at 30 and 60 minutes after administration of cosyntropin,” explained Dr. Glenda Graves. Cosyntropin is a synthetic form of ACTH used for stimulation (or stim) tests. “To this day, we’re not sure why we measure the 30 minute serum cortisol level.”
Many endocrinologists like Graves believe the 30-minute serum cortisol level is critically important, granted the reason for why this is the case eludes them. In order to maximize the utility of the test then, the ES recommends grabbing serum cortisol levels every 60 seconds.
“There is nothing we would like to do more than to drop everything we’re doing and draw labs sixty times an hour,” explained Nurse Amy Parihar, who speaks on behalf of both nursing and phlebotomy. “If there was something better than titrating an insulin drip, this is it!”
The ES believes patients won’t mind the 58 additional lab draws.
The medical laboratory at D.C. Medical Center plans on utilizing what they have dubbed a “phlebotomy conga line” in which 60 phlebotomists line-up at the patient’s bedside in order to effectively carry out the new ACTH stim test.
The ES wants to remind health care professionals that the inability to obtain anything less than 60 serum cortisol levels during the hour-long test voids the results.
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