Pituitary hormone circadian rhythm alterations in cirrhosis patients with subclinical hepatic encephalopathy.
OBJECTIVE
To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis.


METHODS
Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation.


RESULTS
Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were low and correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency.


CONCLUSIONS
Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.
Velissaris
Dimitrios
D
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Patras, Rion 26500, Greece.
Karanikolas
Menelaos
M
Kalogeropoulos
Andreas
A
Solomou
Ekaterini
E
Polychronopoulos
Panagiotis
P
Thomopoulos
Konstantinos
K
Labropoulou-Karatza
Chrissoula
C
D000368:Aged; D002940:Circadian Rhythm; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood*; D008297:Male; D008550:Melatonin / Q000097:blood; D008875:Middle Aged; D010907:Pituitary Hormones / Q000097:blood*; D011388:Prolactin / Q000097:blood; D013972:Thyrotropin / Q000097:blood
D010907:Pituitary Hormones; D011388:Prolactin; D013972:Thyrotropin; D008550:Melatonin; D006854:Hydrocortisone