The short Synacthen test is a test of adrenal insufficiency which can be used as a screening procedure in the non-critically ill patient. The test is based on the measurement of serum cortisol before and after an injection of synthetic ACTH.

This test is not recommended if pituitary problems are suspected. An endocrine referral is required in this situation as alternate stimulation tests may be necessary.

Blood, 4ml x 3

Plain tube

Stop hydrocortisone or prednisolone for 24 hours prior to sampling. But if this is impractical, switch hydrocortisone/prednisolone to dexamethasone on 24 hours prior to sampling.

Label plain tube with two identifier (Name and identity no - NRIC/MRN) and label clearly sample type - 0 min, 30 min or 60 min.

1. Take a baseline blood sample for cortisol.

2. Give the 250 mcg of Synacthen by intramuscular (IM) injection. Record date & time of Synacthen administration.

3. Take another blood sample for cortisol at 30 minutes and 60 minutes post injection.

4. Send all samples to the laboratory with one completed request form giving clinical details, any relevant drugs (especially steroid treatment).

Ensure that you have read the contraindications and precautions as given in the Synacthen product information sheet. Having done so it is the responsibility of the investigating medical officer to decide whether it is safe to proceed with this investigation.

Preparations should be made in advance to combat any anaphylactic reaction that may occur after the injection of Synacthen.

This test gives unreliable results within 2 weeks of pituitary surgery.