Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis.
نویسندگان
چکیده
INTRODUCTION AND AIMS Adrenal insufficiency (AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. MATERIAL AND METHODS We studied 40 stable patients with cirrhosis. We determined the basal total (BTC) and peak cortisol (PTC) levels. Using the ITT, we defined AI as a serum PTC < 18 μg/dL at 30 min after insulin-induced hypoglycemia. We assessed the diagnostic accuracy of BTC in different stages of liver disease to discriminate between those with NAF and AI. RESULTS Of the 40 patients, 24 (60%) presented with AI. Child-Pugh and MELD scores differed between the NAF and AI groups (Child-Pugh: NAF 7.2 ± 1.7 vs. AI 8.8 ± 2.4, p = 0.024 and MELD: NAF 9.9 ± 2.5 vs. AI 14.9 ± 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 ± 2.4 vs. 12.5 ± 5.2, p < 0.001). A BTC value ≤ 10.0 μg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC ≤ 10.0 μg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh ≥ 9 or MELD ≥ 12). CONCLUSION An algorithm including the use of BTC and the severity of liver disease may be a useful and simple method for assessing adrenal function in stable patients with cirrhosis.
منابع مشابه
Assessment of autonomic nervous system function in patients with non-alcoholic cirrhosis
Automatic dysfunction may contribute to the hemodynamic disturbances in cirrhosis. Tests of autonomic function were performed in 31 patients with non-alcoholic cirrhosis and 30 healthy subjects. Patients were divided into 3 groups according to child- Pugh,s classification ( A.B.C). The patients with moderate and severe cirrhosis( child B,C) had significant parasympathetic disturbance ( in the v...
متن کاملژنیکوماستی و بازنگری الگوریتم تشخیصیGynecomastia and Revising its Diagnostic Algorithm
Background & Aim: Gynecomastia or benign enlargement of breasts in males may occur at any age due to several reasons. The main problem in this disease is finding hidden feminizing tumors in testis or adrenals which can be considered as a dangerous but potentially treatable cause. In this study, we assessed 62 patients with gynecomastia to suggest a new algorithmic approach for evaluation of...
متن کاملEvaluation of Adrenal Function in Nonhospitalized Patients with Cirrhosis
BACKGROUND Patients with cirrhosis and advancing hepatic insufficiency may show various degrees of other organ malfunction, including brain, kidney, and lung. Several studies have also shown a high prevalence of adrenal insufficiency in cirrhotic patients that may cause hemodynamic instability. MATERIALS AND METHODS In this study we prospectively evaluated adrenal function in a population of ...
متن کاملThe comparison of a,AT phenotypes in some HBsAG-positive patients with and without cirrhosis in Tehran
Alpha-1- antitrypsin is the most important serine protease inhibitor in serum. This protein has several phenotypes. Some of these phenotypes such as MZ, M, Z, M, S, MS, ZZ,…. Cause a,AT deficiency which leads to damage in many tissues such as liver, lung, kidney. 60 patients and 28 healthy individuals (control group), aged 7-65 years old were studied for a,AT activity and a,AT phenotypes. The c...
متن کاملA diagnostic model for cirrhosis in patients with non-alcoholic fatty liver disease: an artificial neural network approach
Background :Timely diagnosis of liver cirrhosis is vital for preventing further liver damage and giving the patient the chance of transplantation. Although biopsy of the liver is the gold standard for cirrhosis assessment, it has some risks and limitations and this has led to the development of new noninvasive methods to determine the stage and prognosis of the patients. We aimed to design an...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Annals of hepatology
دوره 16 5 شماره
صفحات -
تاریخ انتشار 2017