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Short Synacthen test (SST)
Related Subjects: |Adrenal Physiology |Addisons Disease |Phaeochromocytoma |Adrenal Adenomas |Adrenal Cancer |Cushing Syndrome |Cushing Disease |Congenital Adrenal hyperplasia |Primary hyperaldosteronism (Conn's syndrome) |ACTH |McCune Albright syndrome
If 8-10am cortisol >350nmol/L, SST usually not required for assessment. If done a cortisol of >420nmol/L at 30 minutes post-Synacthen indicates an adequate adrenal response.
ℹ️ About
- It is used to test for Addison's disease or suspected ACTH deficiency
Method
- Synthetic ACTH (ACTH 1-24) 250 mcg Tetracosactrin is given IM
- Cortisol measured at 0 and 30 minutes
- Blood taken and placed into a Serum Gold top container
- Stored in the fridge if delayed to lab
- Smaller doses of synthetic ACTH, as low as 1 mcg, have been used which may be more physiological
Note
- In order to perform the ACTH stimulation test in an acute situation e.g. acute adrenal crises, the patient should be switched to dexamethasone and the test performed 24-36 hours later
- Avoid in ICU patients or those who are severely unwell.
- Avoid post pituitary surgery for 6 weeks or with pituitary apoplexy.
- Discuss with endocrinology if hypoadrenalism suspected. If any delay treat first Hydrocortisone 100 mcg IV.
🔎 Investigations
- A cortisol of = 420nmol/L at 30 minutes post dose is an adequate adrenal response.
- Normal if the rise in plasma cortisol concentration increases by 170-200 nmol/litre (70 micrograms/litre)
- Use local laboratory lab references
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