The cortisol stimulation test measures cortisol production by injecting synthetic ACTH and measuring cortisol levels before and after. Low cortisol levels may indicate adrenal gland problems, such as Addison’s disease. The test can also diagnose other adrenal gland diseases and treatment for Addison’s disease involves cortisol replacement.
A cortisol stimulation test, sometimes known as a synacthen test, is used to investigate the production of the hormone cortisol. Cortisol is normally released by the adrenal glands, located above the kidneys, in response to a hormone known as ACTH, which is produced by the pituitary gland in the brain. During a cortisol stimulation test, a synthetic copy of ACTH is given by injection and blood cortisol levels are measured before and after the injection to see if they rise as expected. If low cortisol levels are found after the test, this could indicate a problem with the adrenal glands.
Cortisol is a necessary hormone that works throughout the body, helping it react to stress, fight infection, and keep blood sugar and blood pressure within normal limits. If the adrenal glands aren’t working properly, this can lead to low cortisol levels, which are associated with a serious condition called Addison’s disease. In Addison’s disease, symptoms affect the whole body but include tiredness, dark spots on the skin, low blood pressure, and nausea. The risk is that, without treatment, a stressful experience such as an infection could suddenly make symptoms worse, leading to a collapse that could be fatal. A cortisol stimulation test is useful to help diagnose the disease.
There are short and long versions of the cortisol stimulation test. In the short version, the cortisol test involves taking a blood sample from a vein to measure cortisol levels. Next, an injection of synthetic ACTH is given, either into a muscle or vein. After waiting for about half an hour, a second blood sample is taken and cortisol levels are measured again to see if the adrenal glands have responded normally to the injection. The longer version of the test is similar but, instead of taking just the second blood sample, a whole series of samples is taken to evaluate cortisol levels and adrenal gland function over 24 hours.
In addition to helping diagnose Addison’s disease, a cortisol stimulation test can indicate whether other diseases are affecting the adrenal glands, such as infections or cancer. If a diagnosis of Addison’s disease is made, treatment is to take a cortisol replacement two to three times a day. Different doses are used, starting the day with higher morning cortisol levels and ending with lower evening cortisol levels, in order to mimic the pattern found in most healthy people.
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