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Clinical Significance. Determination of ACTH is useful in differentiating between primary and secondary adrenocortical hypo-and hyperfunctional disorders: Addison's disease, Cushing's syndrome, adrenal carcinoma, ectopic ACTH syndrome, and adrenal nodular hyperplasia.
1 These patients may not show a significant increase in cortisol output with ACTH stimulation. 2  A normal 30- or 60-minute rapid ACTH test excludes Addison disease but may not adequately exclude mild impairment of the hypothalamic pituitary adrenal axis in secondary adrenal insufficiency. high index of suspicion is necessary for diagnosis. The diagnosis of adrenocortical insufficiency rests on the assessment of the functional capacity of the adrenal cortex to synthesize cortisol. This is accomplished primarily by use of the rapid ACTH stimulation test (Cortrosyn, cosyntropin, or Synacthen).