Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis
| Autor: | Roberto Monreal-Robles, Héctor J. Maldonado-Garza, Jonathan Paz-Delgadillo, Fernando J. Lavalle-González, Jesús Zacarías Villarreal-Pérez, Francisco Bosques-Padilla |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Blood Glucose
Liver Cirrhosis Male Cirrhosis Hydrocortisone Specialties of internal medicine Gastroenterology Cortisol Liver disease Basal (phylogenetics) 0302 clinical medicine Adrenal Glands Prevalence Insulin Adrenal function General Medicine Middle Aged RC581-951 Insulin tolerance test Area Under Curve 030220 oncology & carcinogenesis Critical Pathways Administration Intravenous Female 030211 gastroenterology & hepatology Liver cirrosis Algorithm Algorithms Adult medicine.medical_specialty Hypoglycemia Hepato-adrenal syndrome Decision Support Techniques 03 medical and health sciences Predictive Value of Tests Internal medicine medicine Adrenal insufficiency Humans In patient Mexico Hepatology business.industry Reproducibility of Results medicine.disease Cross-Sectional Studies ROC Curve Adrenal Cortex Function Tests business Biomarkers Adrenal Insufficiency |
| Zdroj: | Annals of Hepatology, Vol 16, Iss 5, Pp 788-796 (2017) |
| ISSN: | 1665-2681 |
| DOI: | 10.5604/01.3001.0010.2797 |
| Popis: | 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 ng/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 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. |
| Databáze: | OpenAIRE |
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