Cortrosyn
Evidence Grade A — Regulatory approved. 655 published studies. 38 registered clinical trials.
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Cosyntropin (sold as Cortrosyn) is not a treatment — it is a diagnostic tool. It is the standard reagent used in the ACTH stimulation test, one of the most commonly performed hormone tests, which checks whether the adrenal glands can produce cortisol normally. Doctors use it to diagnose adrenal insufficiency and to evaluate patients who have been on long-term steroid medications.
655 published studies: 504 human, 51 animal, 7 in-vitro, 62 reviews
Cosyntropin is marketed as Cortrosyn (approved approximately 1970). It is the standard tool for the ACTH stimulation test, one of the most commonly performed endocrine diagnostic procedures. A standard 250 mcg dose is given by injection, with blood cortisol measured at 30 and 60 minutes. A normal response is typically defined as a stimulated cortisol level above 18–20 mcg/dL.
A low-dose (1 mcg) protocol has been studied as a potentially more sensitive test for detecting partial adrenal insufficiency, though the standard 250 mcg dose remains the established clinical practice. Cosyntropin is one of the few peptide compounds used purely for diagnosis rather than treatment.
Cosyntropin mimics the body's natural ACTH by stimulating the adrenal glands to produce cortisol. In a healthy person, a dose of cosyntropin triggers a rapid and substantial rise in cortisol within 30–60 minutes. If the adrenal glands fail to respond adequately (cortisol does not rise above the expected threshold), this indicates adrenal insufficiency — the adrenal glands cannot produce enough cortisol, whether due to primary adrenal failure or prolonged suppression from steroid medications.
Cosyntropin's clinical utility is well established and uncontroversial. The standard test protocol involves injecting 250 mcg and measuring blood cortisol at 30 and 60 minutes — a normal response confirms the adrenal glands are working. The main ongoing clinical discussion concerns what cortisol level counts as a "pass," since newer laboratory methods produce different numbers than older platforms, leading some guidelines to suggest lower thresholds. A low-dose version of the test (1 mcg instead of 250 mcg) has been studied as potentially more sensitive for detecting partial adrenal problems, but the standard dose remains the established practice. No significant research programmes are investigating cosyntropin itself — it is a mature diagnostic tool.
Subclinical Primary Aldosteronism in Diabetes At-Risk for Kidney Disease
Updated Diagnostic Cortisol Values for Adrenal Insufficiency
Positron Emission Tomography (PET) Imaging of Cholesterol Trafficking: Clinical Evaluation of [18F]FNP-59 in Normal Human Subjects (Groups 2, 3 & 4)
Defining the Mechanisms Underlying Adrenal Insufficiency in Cirrhosis
Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism(ADOPA)
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