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

Recreational physical activity is inversely associated with asymptomatic gallstones in adult Mexican women

Background and rationale. Epidemiologic research suggests that physical activity (PA) reduces the risk of chronic diseases including gallstones. Objective. This study explores the association between recreational physica...

Inflammation is not the cause of an elevated serum ferritin in non-alcoholic fatty liver disease

Background. In non-alcoholic fatty liver disease (NALFD), it has often been assumed that an elevation in serum ferritin is likely related to inflammation rather than iron overload. Material and methods. Patients referred...

Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis

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...

Protective and curative effects of polyphenolic extracts from [i]Ichnocarpus frutescense[/i] leaves on experimental hepatotoxicity by carbon tretrachloride and tamoxifen

The aim of this study was to investigate prophylactic and curative effect of polyphenolic extract of Ichnocarpus frutescense against carbon tetrachloride and tamoxifen induced hepatotoxicity in rats. Carbon tetrachloride...

Download PDF file
  • EP ID EP208904
  • DOI 10.5604/01.3001.0010.2797
  • Views 92
  • 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