Cosyntropin - Drug Information | Physicians Office Resource

Overview

Cosyntropin, a synthetic adrenocorticotropic hormone, is principally used in the diagnostic assessment of adrenocortical function.

Cosyntropin is used as an aid in the diagnosis of adrenocortical insufficiency. The 30-minute cosyntropin test (see Dosage and Administration: Dosage) provides a good method of screening for primary adrenocortical insufficiency (Addison's disease) and is preferable to corticotropin for rapid screening since it is less likely to cause allergic reactions. When a greater stimulus to the adrenal cortex is desired, corticotropin or cosyntropin may be administered by IV infusion.

If subnormal increases in plasma cortisol concentrations occur following administration of corticotropin or cosyntropin, additional tests providing prolonged stimulation of the adrenal cortex are required before impaired adrenocortical function can be diagnosed precisely and differentiation between primary and secondary adrenocortical insufficiency can be established.

Generic name: cosyntropin

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Indications

The following indications are listed for Cosyntropin:

Acute Adrenocortical Insufficiency
Diagnostic Test For Secondary Adrenocortical Insufficiency

Also known as: Acute Adrenal Insufficiency, Addisonian Crisis, Addisonian Shock, Adrenal Crisis, Bernard-Sergent Syndrome, Diagnostic Exam For Secondary Adrenocortical Insufficiency, Diagnostic Test For Relative Adrenocortical Suppression.

Dosing

For rapid screening for adrenocortical insufficiency, plasma cortisol concentrations are determined prior to and 30 minutes after administration of 0.25 mg of cosyntropin IM or by direct IV injection over a 2-minute period. In children younger than 2 years of age, a dose of 0.125 mg may be adequate. In one study, neonates were given cosyntropin 0.015 mg/kg IM. Since peak plasma cortisol concentrations usually occur 45-60 minutes after cosyntropin administration, some clinicians prefer to determine plasma cortisol concentrations at 60 minutes following injection of the drug. Although the 60-minute values are usually somewhat higher than the 30-minute values, the difference in most patients is probably not enough to outweigh the disadvantages of a longer testing period.

In patients with normal adrenocortical function, baseline plasma cortisol concentrations are greater than 5 mcg/dL, and 30-minute plasma cortisol concentrations are greater than 18 mcg/dL, with an increase of at least 7 mcg/dL above the control value. If the 60-minute test is used, a normal response is indicated by doubling of the baseline plasma cortisol concentration with an increase of 11 mcg/dL above the baseline value. Baseline plasma cortisol concentration and the degree of increase above the baseline concentration exhibit marked diurnal variation. However, the cortisol plasma concentration at 30 minutes following cosyntropin administration is constant, regardless of the time of the day, and the 30-minute plasma concentration (i.e., greater than 18 mcg/dL) should be the only criterion when tests are performed at various times during the day.

When a greater stimulus to the adrenal cortex is desired, 0.25 mg of cosyntropin may be added to dextrose or sodium chloride infusions and administered over a 4- to 8-hour period. Usually the drug is administered at a rate of approximately 0.04 mg per hour over a 6-hour period. The adrenal response may be measured by determining plasma cortisol concentrations or 24-hour urinary 17-OHCS and 17-KS excretion prior to and at the end of the infusion; plasma cortisol concentrations are usually better indicators of adrenal function than is urinary steroid excretion.

When subnormal cosyntropin test results are obtained, the patient is assumed to have adrenocortical insufficiency and further testing is required to determine if the insufficiency is primary or secondary and to determine the etiology of the insufficiency. The manufacturer of cosyntropin recommends that patients with subnormal cosyntropin test results be given 40 units of repository corticotropin injection IM twice daily for 4 days or 60 units twice daily for 3 days, followed by a second cosyntropin test. However, most clinicians recommend an 8-hour corticotropin infusion on each of 4-5 successive days, followed by a second rapid-screening cosyntropin test. In patients with primary adrenocortical insufficiency, there will be little or no increase in plasma cortisol concentrations following the second cosyntropin test; patients with secondary adrenocortical insufficiency will have higher or even normal plasma cortisol concentrations.

Drug interactions

Patients receiving cortisone or hydrocortisone on the test day may exhibit abnormally high baseline plasma cortisol concentrations and a paradoxical decrease in plasma cortisol concentrations following administration of cosyntropin. Patients receiving estrogens may have abnormally elevated plasma cortisol concentrations before and after cosyntropin administration, but a normal incremental response to cosyntropin still occurs. Because spironolactone metabolites fluoresce, erroneously high plasma cortisol concentrations may be reported in patients receiving spironolactone when fluorometric analysis is used but not when radioimmunoassay or competitive protein binding methods are used. Patients should not receive pretest doses of cortisone, hydrocortisone, or spironolactone on the day of testing when the fluorometric method is used; pretest doses of spironolactone can be given on the day of testing when radioimmunoassay or competitive protein binding methods are used. Since prednisone, dexamethasone, and betamethasone are not detectable by the fluorometric method, therapy with these drugs can be maintained. In patients with increased plasma bilirubin concentrations or with free hemoglobin in the plasma, falsely elevated fluorescence measurements may occur.

Contraindications

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Adverse reactions

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Precautions

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ICD codes

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Cosyntropin (cosyntropin)