Clinical characteristics and prevalence of adrenal insufficiency in hemodynamically stable patients with cirrhosis. Issue 26 (June 2018)

• Record Type: Journal Article
• Authors: Park, Sang Hoon; Joo, Min Sun; Kim, Byoung Hoon; Yoo, Ha Na; Kim, Sung Eun; Kim, Jin Bae; Jang, Myoung Kuk; Kim, Dong Jun; Lee, Myung Seok
• Other Names: Marinho. Rui section editor.
• Is Part Of: Medicine. Volume 97:Issue 26(2018)
• Publication Date: 2018-06
• Subjects: adrenal insufficiency -- adrenocortical hormones -- hemodynamic stability -- liver cirrhosis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000011046
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : 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.