
Children and Young People’s Endocrine Team
Your Child has been asked to come to the Paediatric Day unit for a Standard Short Synacthen Test

The purpose of this test is to assess the production of an important hormone called CORTISOL which is normally produced by the Adrenal glands. These are situated just above the kidneys.
What is cortisol?
Cortisol is a hormone which helps the body to cope with stressful situations, for example illness.
Its job is to regulate the blood glucose levels. The release of Cortisol is controlled by a messenger hormone called ACTH (adrenocorticotrophic hormone) which comes from another gland, deep in the brain, called the Pituitary Gland.
In order to assess if your child is producing enough cortisol to help their body cope with stressful situations and be able to regulate their glucose level, we need to assess the response to an injection of the messenger hormone ACTH.
Your child does not need to have any special preparation prior to the test and can have their breakfast as normal.
If your child is on steroid medication (e.g. hydrocortisone, alkindi, prednisolone or dexamethasone) please omit their usual morning dose on the day of the test and they can have it once the test is completed.
This test is best performed on a morning.
PDU (Paediatric Day Unit) is in the Maternity entrance to the hospital, up the stairs, turn right along the corridor and next to ward 21.
Please note there is a parking charge and parking can on occasion be a problem, so please allow sufficient time before your appointment.
The test
The test involves inserting a cannula into a vein. This is a very small plastic tube which has a needle inside it.
The needle pierces the skin and introduces the plastic tube into a vein, usually the back of the hand or inside the elbow. The needle is then removed leaving the cannula inside the vein; it is secured in place with tape and a bandage and flushed with saline to keep it from blocking.

Before we insert the cannula, we normally use local anaesthetic spray (cryogesic), to numb the area which works immediately. Alternatively, we can use local anaesthetic cream (LMX) which takes about 45 min to 1 hour to work.
We will let you choose which you would prefer on the day of the test.
Once the cannula is inserted a sample of blood will be drawn from it. This is the baseline level which will let us know how much Cortisol and ACTH are already circulating in the system. Any other blood tests that the doctor has requested will also be taken at this time.

An injection of the messenger hormone ACTH (Synacthen) will then be injected via the cannula. Synacthen is a synthetic form of the natural messenger ACTH, produced by the pituitary gland (SynACTHen). The dose will be calculated by the doctor or specialist nurse. Its aim is to stimulate the Adrenal glands to produce Cortisol.
There should not be any side effects from the medication, however, please be assured that we will observe your child closely for any unwanted effects and act on them accordingly.
30 minutes after the injection of Synacthen, a further blood sample will be drawn from the cannula and again at 60 minutes.
The cannula can then be removed, and you will be able to go home.
The samples will be sent to the labs and when we get the results, it will allow us to determine the amount of cortisol that your child has produced in response to the stimulation.
Results

The results will go to the Consultant who has requested the test. They usually take around 2 weeks, though please be assured that if there were a problem we would contact you sooner than this.
Your Consultant will usually explain the results to you at your next outpatient appointment, where the next course of action can be discussed and decided upon.
Contact us
If you have any further questions regarding the test, please do not hesitate to contact:
Children’s endocrine nurse – Julie Stonehouse
Telephone: 01642 854660/01642 850850 Ext 56821 (Monday and Tuesday only)
Email: [email protected]
Dr Burns
Telephone: 01642 854869
Dr Balasubrahmanyam
Telephone: 01642 282723
Dr Raman
Telephone: 01642 854834
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the patient experience department of any special requirements, for example; braille or large print by emailing: [email protected]
The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850
