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Home/Compounds/Cosyntropin
OtherFDA approvedRx required

Cosyntropin

Also known as: Cortrosyn · Tetracosactide · Synacthen
Brands: Cortrosyn

Synthetic 24-amino-acid ACTH fragment used diagnostically for adrenal insufficiency.

A
Grade A
Multiple human RCTs
Human studies25
PubMed citations29
Routeintravenous, intramuscular
Regulatory (US)FDA approved · Rx
Last verified2 days ago

Mechanism of action

Synthetic peptide comprising the first 24 amino acids of ACTH — the minimum sequence required for full activity at the melanocortin-2 receptor.

Evidence summary

25
Human studies
29
PubMed citations
25
Clinical trials
A
Evidence grade

Evidence summary in progress. See the citations section below for the underlying research papers.

Dosing protocols

Educational information only. Consult a licensed provider before using any peptide.
Administration routes
intravenousintramuscular

Side effects & safety

From the FDA label
Source
rashtachycardia

Terms pulled directly from the referenced source. We don't fabricate frequencies — when a label doesn't publish a percentage, we don't either.

Interactions

No documented drug interactions on file.

Regulatory status

United States
FDA approved

FDA approved as a diagnostic agent for adrenal insufficiency (Cortrosyn)

Compounding
Not permitted

Not available via 503A/503B compounding pharmacies.

Regulatory data last verified 4/19/2026

Clinical trials

NCT05149638Re-assessment of Diagnostic Cortisol Values for Adrenal Insufficiency Using a Highly Specific Cortisol AssayRecruiting · N/A · Adrenal Insufficiency · n=90NCT04546126Positron Emission Tomography (PET) Imaging of Cholesterol Trafficking: Clinical Evaluation of [18F]FNP-59 in Normal Human Subjects (Groups 2, 3 & 4)Recruiting · Phase 1 · Radiotracer · n=24NCT02339506Stress and the Nervous SystemCompleted · N/A · Autonomic Nervous System · n=23NCT03142893Hormonal Mechanisms of Sleep Restriction - Axis StudyActive Not Recruiting · Phase 1 · Sleep Restriction · n=80NCT04037605Hormonal Mechanisms of Sleep Restriction - Axis Study in Older Men and Postmenopausal WomenActive Not Recruiting · Phase 1 · Sleep Restriction · n=5NCT02813655Evaluation of the Effectiveness and Tolerance of Tetracosactide Synacthen® in the Treatment of Post Dural Puncture Headaches (ESYBRECHE)Terminated · Phase 2 · Post-dural Puncture Headache · n=46NCT06190158Subclinical Primary Aldosteronism in Diabetes At-Risk for Kidney DiseaseRecruiting · Phase 1 · Type 2 Diabetes · n=125NCT04642391Defining the Mechanisms Underlying Adrenal Dysfunction in Cirrhosis and Its Prognostic SignificanceCompleted · Cirrhosis · n=76NCT03514589NeSST2: A Multi-stage Clinical Study to Develop a Non-invasive Short Synacthen Test (SST)Recruiting · Phase 2 · Adrenal Suppression · n=12NCT02818660Mass Spectrometry Based Cutoffs for Cortisol and 17-hydroxy-progesterone (17-OH-progesterone) After Stimulation Tests for Primary and Secondary Adrenal Insufficiency.Completed · N/A · Adrenal Insufficiency · n=232NCT04461535Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism The ADOPA Randomized Clinical TrialCompleted · N/A · Primary Aldosteronism · n=228NCT03793114Residual Secretion of Adrenal Steroid Hormones in Addison's DiseaseUnknown · N/A · Primary Adrenal Insufficiency · n=200

Showing 12 of 25 indexed studies. View all on ClinicalTrials.gov →

Citations

PMID 41410035Vibhatavata P, Mermejo LM et al. · Partially Successful Adrenal Vein Sampling With and Without Cross-Sectional Imaging in Primary Aldosteronism Subtyping.Hypertension (Dallas, Tex. : 1979) (2026)HumanPMID 40393818Dziadzko M, Bouvet L et al. · No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: a double-blind randomised controlled clinical trial.British journal of anaesthesia (2025)HumanPMID 40909228Lewandowski KC, Skowrońska-Jóźwiak E · Editorial: Progress in diagnosis and treatment of hypothalamic & pituitary disorders.Frontiers in endocrinology (2025)PMID 38222249Zojaji F, Khalesi A et al. · Evaluation of Serum Cortisol Levels and Response to Cosyntropin Test in Methadone-treated Opium Addicts.Anesthesiology and pain medicine (2024)HumanPMID 37922711Wyatt S, Singer L et al. · Adrenocortical hemorrhage following intravenous tetracosactide in a dog with hypercortisolism.Journal of the American Veterinary Medical Association (2024)HumanPMID 37651920Liu M, Mitchell A et al. · Role of cosyntropin in the prevention of post-dural puncture headache: a propensity-matched retrospective analysis.International journal of obstetric anesthesia (2023)HumanPMID 37459957Soylu S, Cherkezzade M et al. · Distribution of peripheral blood mononuclear cell subtypes in patients with West syndrome: Impact of synacthen treatment.Immunology letters (2023)HumanPMID 36621063Osborne JP, Edwards SW et al. · Prednisolone or tetracosactide depot for infantile epileptic spasms syndrome? A prospective analysis of data embedded within two randomised controlled trials.European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society (2023)HumanPMID 36958832Lewis A, Thant AA et al. · Diagnosis and management of adrenal insufficiency.Clinical medicine (London, England) (2023)HumanPMID 35044272Knupp KG, Coryell J et al. · Comparison of Cosyntropin, Vigabatrin, and Combination Therapy in New-Onset Infantile Spasms in a Prospective Randomized Trial.Journal of child neurology (2022)HumanPMID 35795807Suzuki S, Ruike Y et al. · Clinical Usefulness of the Growth Hormone-Releasing Peptide-2 Test for Hypothalamic-Pituitary Disorder.Journal of the Endocrine Society (2022)PMID 32593173Elder CJ, Vilela R et al. · Pharmacodynamic studies of nasal tetracosactide with salivary glucocorticoids for a noninvasive Short Synacthen Test.The Journal of clinical endocrinology and metabolism (2021)HumanPMID 31863094Napier C, Gan EH et al. · Residual Adrenal Function in Autoimmune Addison's Disease-Effect of Dual Therapy With Rituximab and Depot Tetracosactide.The Journal of clinical endocrinology and metabolism (2021)HumanPMID 31606056Vinolas H, Lombès M et al. · [Not Available].Annales d'endocrinologie (2020)HumanPMID 31176302Deinum J, Groenewoud H et al. · Adrenal venous sampling: cosyntropin stimulation or not?European journal of endocrinology (2020)HumanPMID 30427776Ceccato F, Scaroni C · Central adrenal insufficiency: open issues regarding diagnosis and glucocorticoid treatment.Clinical chemistry and laboratory medicine (2020)HumanPMID 27015690Hanling SR, Lagrew JE et al. · Intravenous Cosyntropin Versus Epidural Blood Patch for Treatment of Postdural Puncture Headache.Pain medicine (Malden, Mass.) (2020)PMID 31915040Depaulis C, Steer N et al. · Evaluation of the effectiveness and tolerance of tetracosactide in the treatment of post-dural puncture headaches (ESYBRECHE): a study protocol for a randomised controlled trial.Trials (2020)HumanPMID 29106701Elder CJ, Harrison RF et al. · Use of salivary cortisol and cortisone in the high- and low-dose synacthen test.Clinical endocrinology (2019)HumanPMID 29174200Chanson P, Guignat L et al. · Group 2: Adrenal insufficiency: screening methods and confirmation of diagnosis.Annales d'endocrinologie (2018)Human

Showing 20 of 29 papers. View all on PubMed →