Apolipoprotein AI and HDL are reduced in stable cirrhotic patients with adrenal insufficiency: a possible role in glucocorticoid deficiency. (March 2014)

• Record Type: Journal Article
• Authors: Spadaro, Luisa; Noto, Davide; Privitera, Graziella; Tomaselli, Tania; Fede, Giuseppe; Scicali, Roberto; Piro, Salvatore; Fayer, Francesca; Altieri, Ida; Averna, Maurizio; Purrello, Francesco
• Is Part Of: Scandinavian journal of gastroenterology. Volume 50:Number 3(2015)
• Page Start: 347
• Page End: 354
• Publication Date: 2014-03
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2014.985707
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Backgrounds and aims:</italic> </bold> Adrenal insufficiency (AI) has been reported in patients with stable cirrhosis. A lack of substrates has been suggested as a possible contributing pathogenic mechanism leading to glucocorticoid deficiency in these subjects. To better explore this hypothesis, we studied lipoproteins in cirrhotics with and without AI. <bold><italic>Methods.</italic></bold> A total of 81 cirrhotic patients and 30 normal volunteers were enrolled. The severity of liver disease was graded by Child-Pugh score. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and apolipoprotein AI (Apo-AI) levels were evaluated. HDL subfractions were measured by gradient gel electrophoresis. Adrenal function was assessed by the Low-Dose Short Synacthen Test. <bold><italic>Results.</italic></bold> Cirrhotic patients showed a significant reduction of TC, HDL, LDL, TG, and Apo-AI levels compared with controls. HDL3 was significantly lower, while HDL2 was higher, in cirrhotics compared with the controls. AI was observed in 26 patients. TC, TG, HDL, and Apo-AI were significantly reduced in cirrhotics with AI compared with those with normal adrenal function. HDL2 and HDL3 did not differ between these two groups. Delta cortisol was related to TC (<italic>r</italic> = 0.30, <italic>p</italic> < 0.01), TG (<italic>r</italic> = 0.22, <italic>p</italic> = 0.05), and Apo-AI (<italic>r</italic> = 0.37, <italic>p</italic> < 0.001). Multivariate analysis revealed that Apo-AI and HDL were independently associated with AI. <bold><italic>Conclusion.</italic></bold> Our study shows that TC, TG, HDL, and Apo-AI are reduced in cirrhotics with AI. In particular, because both HDL and Apo-AI play a primary role in providing substrates for steroidogenesis to adrenal cells, this deficiency may contribute to the pathogenesis of AI in these patients.</p> </abstract>