Assessment of adrenocortical reserve in stable patients with cirrhosis

Reduced cortisol in the absence of bacterial infection in patients with hepatitis B virus cirrhosis

“…Therefore, the biological activity of COR in patients is better reflected by the FC level. Fede et al (2011) studied 101 non-infected cirrhotic patients with stable hemodynamic status and demonstrated that the correlation coefficient between FC and basal COR was 0.94 because of the existence of CBG, whereas the correlation coefficient between FC and peak COR was 0.90. Similarly, in our research, the correlation coefficient between FC and COR was 0.907.…”

“…Relative adrenal insufficiency has recently been described in 62-80% of heterogeneous groups of patients with liver disease (Arabi et al, 2010). Adrenal insufficiency can affect the liver function, increase the mortality, and seriously influence the prognosis (O'Beirne et al, 2007;Aravinthan et al, 2009;Galbois et al, 2010;Fede et al, 2011). Our study explored whether cortisol (COR) levels are reduced in patients with HBV cirrhosis and what factors correlate with COR level.…”

Adrenal insufficiency

“…This may not be correct and traditional assays based on serum total cortisol levels may be inaccurate due to patients with cirrhosis having subnormal CBG or albumin levels leading to a spuriously low total cortisol level and hence overestimation of the prevalence of AI. Differences also exist in the stimulation tests used: some studies have used the low dose (1 μg) Synacthen test, as opposed to the standard dose of 250 μg [9]. This renders studies difficult to compare, and provides challenges with regards to collating data from multiple studies [29].…”

“…RAI appears to be prevalent in patients with cirrhosis and septic shock and is associated with increased mortality [8]. RAI has also been identified in patients with stable cirrhosis, nonseptic complications of cirrhosis (bleeding, ascites), and in patients postliver transplantation [9]. The presence of AI even in the absence of critical illness in patients with cirrhosis suggests that adrenal dysfunction may be a complication of liver disease per se, leading to the term hepato-adrenal syndrome [10].…”

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

“…It has critical roles in the maintenance of normal functions in the immune system, vascular tone, cardiac output, metabolic states, and several other cellular processes (1,2). The prevalence of adrenal insufficiency (AI) has been reported to be 66% in decompensated cirrhosis, 33% in acute liver failure, 72% in patients in transplantation centers, 51% in cirrhotic patients with sepsis, 68-77% in cirrhotic patients with septic shock, and 38% in stable cirrhotic patients without any hemodynamic instability (1,(3)(4)(5)(6)(7).…”