Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis

Journal Title: Annals of Hepatology - Year 2017, Vol 16, Issue 5

Abstract

Introduction and aims. Adrenal insufficiency (AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. Material and methods. We studied 40 stable patients with cirrhosis. We determined the basal total (BTC) and peak cortisol (PTC) levels. Using the ITT, we defined AI as a serum PTC < 18 μg/dL at 30 min after insulin-induced hypoglycemia. We assessed the diagnostic accuracy of BTC in different stages of liver disease to discriminate between those with NAF and AI. Results. Of the 40 patients, 24 (60%) presented with AI. Child-Pugh and MELD scores differed between the NAF and AI groups (Child-Pugh: NAF 7.2 ± 1.7 vs. AI 8.8 ± 2.4, p = 0.024 and MELD: NAF 9.9 ± 2.5 vs. AI 14.9 ± 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 ± 2.4 vs. 12.5 ± 5.2, p < 0.001). A BTC value ≤ 10.0 μg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC ≤ 10.0 μg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh ≥ 9 or MELD ≥ 12). Conclusion. An algorithm including the use of BTC and the severity of liver disease may be a useful and simple method for assessing adrenal function in stable patients with cirrhosis.

Authors and Affiliations

Jonathan Paz-Delgadillo, Roberto Monreal-Robles, Jesús Z. Villarreal-Pérez, Héctor J. Maldonado-Garza, Francisco J. Bosques-Padilla

Keywords

Related Articles

Hepatocellular carcinoma that arose from primary Sjögren’s syndrome

Hepatocellular carcinoma (HCC) typically originates from HBV or HCV associated liver cirrhosis. Primary Sjögren’s syndrome (pSS) is a kind of autoimmune disease. A sixty-two year old female patient with mild liver damage...

Pulmonary vascular clearance of harmful endogenous macromolecules in a porcine model of acute liver failure

Background. Pulmonary complications are common in acute liver failure (ALF). The role of the lungs in the uptake of harmful soluble endogenous macromolecules was evaluated in a porcine model of ALF induced by hepatic de...

Minimally invasive treatment of Mirizzi’s syndrome: is there a safe way? Report of a case series

Mirizzi’s syndrome (MS) is a rare complication of the inveterate biliary lithiasis. Diagnostic and therapeutic standardization is still missing, especially since laparoscopic cholecystectomy has become the gold standard...

Treatment of Chronic HCV Infection with the New Direct Acting Antivirals (DAA): First Report of a Real World Experience in Southern Brazil

Introduction and aim. There is almost no data regarding the efficacy of direct acting antivirals (DAAs) therapy in Brazil. The aim of this historical cohort study is to describe the sustained virologic response (SVR) rat...

Thyroid-like cholangiocarcinoma of the liver: an unusual morphologic variant with follicular, trabecular and insular patterns

We report the case of a 26-year-old woman with a 19 cm malignant hepatic neoplasm with morphological features that closely resembled a follicular thyroid carcinoma. Despite this, it was interpreted as a cholangiocarcinom...

Download PDF file
  • EP ID EP208904
  • DOI 10.5604/01.3001.0010.2797
  • Views 109
  • Downloads 0

How To Cite

Jonathan Paz-Delgadillo, Roberto Monreal-Robles, Jesús Z. Villarreal-Pérez, Héctor J. Maldonado-Garza, Francisco J. Bosques-Padilla (2017). Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis. Annals of Hepatology, 16(5), 788-796. https://europub.co.uk/articles/-A-208904