title: [Adrenal insufficiency in cirrhotic patients].
abstract: Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.E-mail:forozco@hospitalaleman.com.
authors: Federico
authors: F
authors: Orozco
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.
authors: María
authors: M
authors: Anders
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.
authors: José
authors: J
authors: Mella
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.
authors: Florencia
authors: F
authors: Antinucci
authors: Laboratorio Central, Hospital Alemán, Argentina.
authors: Patricia
authors: P
authors: Pagano
authors: Laboratorio Central, Hospital Alemán, Argentina.
authors: Paula
authors: P
authors: Esteban
authors: Unidad de Hepatología, Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors: Mariano
authors: M
authors: Cartier
authors: Unidad de Hepatología, Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors: Gustavo
authors: G
authors: Romero
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.
authors: Bettina
authors: B
authors: Francini
authors: Servicio de Hepatología y Unidad de Trasplante, Hospital Alemán, Argentina.
authors: Ricardo
authors: R
authors: Mastai
mesh_terms: D000309:Adrenal Insufficiency / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry; D018805:Sepsis
chemical_list: D006854:Hydrocortisone
keywords: ACTH; Child-Pugh; cirrhosis; liver function; relative adrenal insufficiency; survival