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South Australian Neonatal Medication Guidelines 

Tetracosactide(tetracosactrin) 
 250microgram/1mL ampoule 

  Department for Health and Wellbeing, Government of South Australia. All rights reserved.  

INFORMAL COPY WHEN PRINTED  Page 1 of 4 

Public-I4-A1 
 
 

Note:
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  
Information in this statewide guideline is current at the time of publication.  
SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 
Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 
If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 
This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

 

This monograph does not include the use of tetracosactide 
(tetracosactrin) depot injection for infantile spasms.  

Synonyms 
Synacthen , tetracosactrin, cosyntropin, corticotrophin (ACTH) analogue 

Dose and Indications 

Diagnosis/screening of adrenocortical insufficiency 

Advice of a paediatric endocrinologist should always be sought before undertaking any such 
test in the neonatal period. 

Standard dose (Short Synacthen  Test) 

Intravenous 

250microg/m2 as a single dose (maximum 125microg) 

??? (?2) = ???????(??)   ??????(??)3600  
Low dose (Low Dose Short Synacthen  Test) 

Intravenous 

1microgram as a single dose, regardless of weight 

 



South Australian Neonatal Medication Guidelines 

Tetracosactide (tetracosactrin) 
 250microgram/mL ampoule 
 

 

 
INFORMAL COPY WHEN PRINTED  Page 2 of 4 

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Preparation and Administration 

Dose to be administered by a medical officer 

Standard dose test 

Intravenous 

Dilute 1mL (250microg) tetracosactide(tetracosactrin) up to 10mL with sodium chloride 0.9%. 
The resulting solution contains 25microg/mL. Give required dose as a bolus over 2 minutes. 

Dose 25microg 37.5microg 50microg 62.5microg 75microg 

Volume 1mL 1.5mL 2mL 2.5mL 3mL 

Low dose test 

Intravenous 

There are TWO steps to this process. 

STEP ONE: Take 1mL of 250microgram/mL tetracosactide(tetracosactrin) and dilute with 
49mL of 0.9% sodium chloride to make a concentration of 5microgram/mL 

STEP TWO: Take 1mL of the 5microgram/mL tetracosactide(tetracosactrin) solution and 
dilute with 4mL 0.9% sodium chloride to make a 1microgram/mL solution 

Use immediately. Do not store solution for further use. 

Give as a bolus over 2 minutes. 

Compatible Fluids 
Glucose 5%, sodium chloride 0.9% 

Adverse Effects 
Rare 
Anaphylactic and hypersensitivity reactions have been reported; therefore dose should be 
administered under medical supervision. Most severe reactions occur within 30 minutes. 

 

 

 

 



South Australian Neonatal Medication Guidelines 

Tetracosactide (tetracosactrin) 
 250microgram/mL ampoule 
 

 

 
INFORMAL COPY WHEN PRINTED  Page 3 of 4 

Public-I4-A1 
 
 

Monitoring 
&gt; Cortisol levels (and 17OHP, if considering congenital adrenal hyperplasia) are taken 

immediately before the dose, 30 minutes and 60 minutes after the dose 

&gt; ACTH may be requested  

&gt; Exact time of sampling must be indicated on each sample taken 
Sample Tube/vol Baseline (prior to dose) 30min 60min 
Cortisol Li hep/serum 1ml 

 
X X X 

ACTH  EDTA 1ml on ice 
 

X   

17OHP* Li hep 1ml 
 

X X X 

  Take to the lab ASAP, * if indicated  

For absolute minimum collection volumes, contact hospital laboratory 

Interpretation 

Standard dose test 

&gt; Peak cortisol greater than 450nmol/L is considered normal  

&gt; Normal ratio of 17-OHP to cortisol at 30mins &lt;0.023. Ratios up to 0.08 suggest 
heterozygosity for 21-hydroxylase deficiency and ratios &gt;0.1 suggest CAH 

Low dose test 

&gt; Peak cortisol greater than 450nmol/L is considered normal  

Practice Points 
&gt; Standard dose test represents supramaximal stimulus dosing. In the low dose test, much 

smaller doses are used to assess the response of the adrenal gland to a more 
physiological stimulus. 

&gt; Concurrent or recent use of hydrocortisone may interfere with cortisol assays - consult 
endocrinology for advice. 

References 
1. Endocrine &amp; Diabetes Unit, Women s and Children s Health Network, Adelaide, South 

Australia 

2. Bornstein S, Allolio B, Arlt W et al. Diagnosis and Treatment of Primary Adrenal 
Insufficiency: An Endocrine Society Clinical Practice Guideline, 2016, The Journal of 
Clinical Endocrinology &amp; Metabolism, 101 (2), 361-389 

 

 

 



South Australian Neonatal Medication Guidelines 

Tetracosactide (tetracosactrin) 
250microgram/mL ampoule 

INFORMAL COPY WHEN PRINTED Page 4 of 4 

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Document Ownership &amp; History 
Developed by: 
Contact: 
Endorsed by:  
Next review due: 
ISBN number:  
PDS reference:  
Policy history: 

SA Maternal, Neonatal &amp; Gynaecology Community of Practice 
Health.NeoMed@sa.gov.au 
SA Health Safety and Quality Strategic Governance Committee 
12/02/2024 
978-1-76083-053-3
CG309
Is this a new policy (V1)?  Y
Does this policy amend or update and existing policy?   N
If so, which version?
Does this policy replace another policy with a different title?  N 
If so, which policy (title)?

Approval 
Date Version 

Who approved New/Revised 
Version Reason for Change 

12/02/2019 V1 
SA Health Safety and Quality 
Strategic Governance 
Committee 

Original  SA Health Safety and Quality 
Strategic Governance Committee 
approved version 



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