Specimen Requirements

Submit only 1 of the following specimens:
 

Preferred:  

Serum

Draw blood in a gold-top serum gel tube(s). Spin down and send 1 mL of serum refrigerated.  

Note:  

1. Patients receiving cortisone, hydrocortisone, or spironolactone should omit their pre-test doses on day of test. Corticosterone, methylprednisolone, and prednisolone crossreact with assay.

2. Elevated bilirubin and heterophile antibodies may interfere with this assay.

3.A speckled-top serum gel tube (s) or a plain, red-top tube(s) is also acceptable.

4. Indicate serum on request form.

5. Label specimen appropriately (serum).

Alternate:

Plasma

Draw blood in a mint green-top (heparin) gel tube(s). Spin down and send 1 mL of heparinized plasma refrigerated. 

Note:

1. Patients receiving cortisone, hydrocortisone, or spironolactone should omit their pre-test doses on day of test. Corticosterone, methylprednisolone, and prednisolone crossreact with assay.

2. Elevated bilirubin and heterophile antibodies may interfere with this assay.

3. Indicate plasma on request form.

4. Label specimen appropriately (plasma).

Draw specimen using 1 of the following protocols:

Protocol 1:  Routine Test for Adrenal Insufficiency

Inpatients:  Phlebotomy will draw pre-stimulation specimen and notify nursing unit. Nursing will schedule post-stimulation specimen to be drawn 30 or 60 minutes after injection as ordered by physician.

Outpatients:  Procedure is performed at RMH-RHC Infusion Services Department. Call 614-566-5642 to schedule test.

1. Patient must be fasting a minimum of 10 hours.

2. Schedule test to begin at 8 a.m.

3. Draw blood for a baseline cortisol level. Label specimen with time of draw and as “baseline pre-stimulation.”

4. Patient is given a standard dose of Cosyntropin®. Standard dose of Cosyntropin® is 0.25 mg (250 mg) injected intramuscularly or intravenously.

Note:  Questions about dosages should be referred to the Pharmacy Department. Physician may order other dosages and draw times.

5. Draw blood for a cortisol level 30 minutes post injection (if ordered). Label specimen with time of draw and as “30 minutes post stimulation.” (#45323 [Post] “Cortisol, Post Stimulation”)

6. Draw blood for a cortisol level 60 minutes post injection (if ordered). Label specimen with time of draw and as “60 minutes post stimulation.” (#45323 [Post] “Cortisol, Post Stimulation”)

Note:  Physician may order both a 30-minute and a 60-minute post-stimulation level, but usually orders 1 or the other.

Protocol 2:  Inpatient Diagnosis of Adrenal Insufficiency (Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis Published in Critical Care Medicine, March 2004)

1. Order #45324 (Pre) “Cortisol, Pre-Stimulation” to be drawn between 7 a.m. and 8 a.m. Label specimen with time of draw and as “pre-stimulation.”

2. Administer 0.25 mg (250 mg) of Cosyntropin® intravenously directly after pre-stimulation specimen is drawn. Note time that infusion begins.

3. Order #45323 (Post) “Cortisol, Post Stimulation” to be drawn 60 minutes after start of Cosyntropin® infusion. Label specimen with time of draw and as “post stimulation.”

Specimen Stability Information