Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis

Paz Delgadillo, Jonathan y Monreal Robles, Roberto y Villarreal Pérez, Jesús Z. y Lavalle González, Fernando J. y Maldonado Garza, Héctor J. y Bosques Padilla, Francisco J. (2017) Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis. Annals of Hepatology, 16 (5). pp. 788-796. ISSN 16652681

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URL o página oficial: http://doi.org/10.5604/01.3001.0010.2797

Resumen

Introduction and aims. 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 stabl Material and methods. e 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 Pg/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 Results. (Child-Pugh: NAF 7.2 r 1.7 vs. AI 8.8 r 2.4, p = 0.024 and MELD: NAF 9.9 r 2.5 vs. AI 14.9 r 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 r 2.4 vs. 12.5 r 5.2, p < 0.001). A BTC value d 10.0 Pg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC d 10.0 Pg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh t 9 or MELD t 12). Conclusion. An algorithm in- Conclusion. cluding 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.

Tipo de elemento:

Article

Palabras claves no controlados:

Insuficiencia suprarrenal; Síndrome hepatorrenal; Cirrosis hepática; Prueba de tolerancia a la insulina; Cortisol.

Materias:

R Medicina > RC Medicina Interna, Psiquiatría, Neurología

Divisiones:

Medicina

Usuario depositante:

Editor Repositorio

Creadores:

Creador	Email	ORCID
Paz Delgadillo, Jonathan	NO ESPECIFICADO	NO ESPECIFICADO
Monreal Robles, Roberto	NO ESPECIFICADO	NO ESPECIFICADO
Villarreal Pérez, Jesús Z.	NO ESPECIFICADO	NO ESPECIFICADO
Lavalle González, Fernando J.	NO ESPECIFICADO	NO ESPECIFICADO
Maldonado Garza, Héctor J.	NO ESPECIFICADO	NO ESPECIFICADO
Bosques Padilla, Francisco J.	NO ESPECIFICADO	NO ESPECIFICADO