Clinical characteristics and prevalence of adrenal insufficiency in hemodynamically stable patients with cirrhosis

Abstract

It is well known that adrenal insufficiency is common in septic shock or hemodynamically unstable patients. But, there is as yet no sufficient clinically significant data about the exact prevalence or differences in the cause of cirrhosis with adrenal insufficiency. To investigate adrenal insufficiency prevalence in hemodynamically stable patients with cirrhosis and determine differences based on cirrhosis severity or etiology.From July 2011 to December 2012, 69 hemodynamically stable patients with cirrhosis without infection admitted at Hallym University Medical Center were enrolled. Adrenal insufficiency was defined as a peak cortisol level < 18 μg/dL, 30 or 60 minutes after 250 μg Synacthen injection.The study included 55 male patients (79.7%), and the mean age was 57.9 ± 12.9 years. Cirrhosis etiology was alcohol consumption, HBV, HCV, both viral and alcohol related, and cryptogenic in 49, 15, 7, 11, 9 patients, respectively. Adrenal insufficiency occurred in 24 patients (34.8%). No differences were found in age, sex, mean arterial pressure, heart rate, HDL, cirrhosis etiology, degree of alcohol consumption, encephalopathy, variceal bleeding history, or hepatocellular carcinoma between patients with or without adrenal insufficiency. Serum albumin level was lower (P < .05), and INR was higher (P < .05) in patients with than in those without adrenal insufficiency. However, multivariate analysis revealed no independent adrenal insufficiency predictor. Significant negative correlations were found between Child–Pugh score and peak cortisol levels (γ=−0.365, P = .008).Adrenal insufficiency was frequent even in hemodynamically stable patients with cirrhosis and tended to be associated with only liver disease severity, being unrelated to cirrhosis etiology.

Abnormal cholesterol metabolism underlies relative adrenal insufficiency in decompensated cirrhosis

“…In addition, the characterization of RAI in non-critically ill patients with cirrhosis has been somewhat problematic as the optimal methodology for assessing RAI remains debated. [18][19][20] Traditional measurement of HPA axis function relies on the measurement of serum total cortisol levels in response to synacthen administration.…”

Clinical and biochemical factors to predict biochemical adrenal insufficiency in hospitalized patients with indeterminate cortisol levels: a retrospective study

“…Most studies were primarily conducted in cirrhotic patients. For instance, the study from Park et al revealed no association between serum cholesterol and AI in cirrhotic patients, while Spadaro et al stated that cirrhosis with low total cholesterol exhibited an association with AI [17,23]. In the general hospitalized patient, serum total cholesterol level is not associated with serum random cortisol and AI [14].…”

“…Cirrhosis has been reported to be associated with biochemical AI in multiple studies with a prevalence from 25 to 54% [15,16]. The association between biochemical AI and serum albumin and cholesterol has been studied [14,17,18]. However, combined biochemical factors together with clinical factors to predict biochemical AI in hospitalized patients with equivocal serum cortisol levels have not yet been reported.…”

Predictive Factors of Adrenal Insufficiency in Outpatients with Indeterminate Serum Cortisol Levels: A Retrospective Study

“…Previous studies have reported an association between serum cholesterol and AI in cirrhotic patients. Spadaro et al stated that low total cholesterol exhibited an association with AI, while Park et al found no association between serum cholesterol and AI in cirrhotic patients [26,27]. As cholesterol is a precursor of glucocorticoid synthesis, AI may be present when serum cholesterol is lower than normal.…”