Assessment of adrenal function in cirrhotic patients: Salivary cortisol should be preferred

Galbois, Arnaud; Rudler, Marika; Massard, Julien; Fulla, Y.; Bennani, Abdelhai; Bonnefont‐Rousselot, Dominique; Thibault, Vincent; Reignier, Stéphanie; Bourrier, Anne; Poynard, Thierry; Thabut, Dominique

doi:10.1016/j.jhep.2010.01.026

Cited by 103 publications

(122 citation statements)

References 57 publications

(71 reference statements)

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“…Because cirrhotic patients have low CBG levels, standard methods for measuring TC levels (including both free and protein bound fractions) may overestimate the AI rate in this population. In accordance with the literature, in our study, CBG levels decreased from the CTP-A to the CTP-C groups (16,23). Hamrahian et al (10) reported high FC levels in critically ill hypoproteinemia patients who were diagnosed with AI according to basal and post-ACTH levels of TC.…”

Section: Resultssupporting

confidence: 91%

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The importance of salivary cortisol in the diagnosis of adrenal insufficiency in cirrhosis

Araz

Soydas²,

Özer³

et al. 2016

Turk J Gastroenterol

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Section: Resultssupporting

confidence: 91%

“…In hemodynamically stable cirrhotic patients, the prevalence of AI has been reported to be 33% with TC measurements. However, according to SC, only 9.1% of these patients were diagnosed with AI (16).…”

Section: Introductionmentioning

confidence: 96%

The importance of salivary cortisol in the diagnosis of adrenal insufficiency in cirrhosis

Araz

Soydas²,

Özer³

et al. 2016

Turk J Gastroenterol

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“…In contrast, in a study of 57 patients with septic shock, there was no significant difference between free serum cortisol and salivary cortisol levels (p = 0.28) [20]. In addition, the correlation between salivary cortisol and total serum cortisol levels was very good (80%).…”

Section: Rationalementioning

confidence: 76%

“…Furthermore, the practicality and feasibility of using salivary cortisol is questionable given that it is tested by enzyme immunoassay, which may not be routinely available at most centers. Additionally, there are implementation concerns: in the Estrada-Y-Martin study [20], for example, 19 of the 57 patients were excluded because three initial samples did not provide any saliva, and 16 were eliminated owing to insufficient saliva or blood contamination. The task force therefore felt that using salivary cortisol would not be cost effective, practical, or feasible.…”

Section: Rationalementioning

confidence: 99%

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

et al. 2017

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“…Caution should be taken in patients with cirrhosis, nephrotic syndrome, or those taking oral estrogens. 7,8 In these settings, decreased or increased levels may lead to an incorrect diagnosis. Salivary cortisol or free serum cortisol may be the alternative tests.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Adrenal Insufficiency

Ashrafuzzaman

Rahim

2016

Birdem Med J

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Adrenal insufficiency means hypo-function of the adrenal cortex, usually glucocorticoid, may be associated with mineralocorticoid and rarely adrenal androgen. It can be categorized into two types: Primary adrenal insufficiency, or Addison's disease (cortisol low and ACTH high) or secondary/ tertiary adrenal insufficiency due to pituitary or hypothalamic disorders (both cortisol and ACTH are low). Identification of etiology is very important for plan of treatment. The reported incidence of adrenal insufficiency varies greatly depending on the population studied, the test and cut off levels used, and the cause. Many patients may present with adrenal crisis, some of them have subtle symptoms, hyperpigmentation, hypotension, electrolyte imbalance, shock etc. Many of them have iatrogenic adrenal insufficiency with IntroductionAdrenal insufficiency means hypo-function of the adrenal cortex usually glucocorticoid (cortisol) insufficiency. This may be associated with mineralocorticoid (aldosterone) and androgen (DHEAS) insufficiency. The clinical features are usually variable depending on whether the onset is acute, chronic or with adrenal crisis. 1 Adrenal crisis should be considered when patients present with vascular collapse (shock) whether or not known to have adrenal insufficiency. Sometimes these patients are having features of Cushing's syndrome due to chronic steroid use. Some of the patients may present with non-specific symptoms (like fatigue, weakness, anorexia, weakness) etc. Unexplained hyponatremia, hypoglycemia, weight loss should be suspected for chronic adrenal insufficiency.

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Assessment of adrenal function in cirrhotic patients: Salivary cortisol should be preferred

Cited by 103 publications

References 57 publications

The importance of salivary cortisol in the diagnosis of adrenal insufficiency in cirrhosis

The importance of salivary cortisol in the diagnosis of adrenal insufficiency in cirrhosis

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Adrenal Insufficiency

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