Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis

Paz Delgadillo, Jonathan y Monreal Robles, Roberto y Villarreal Pérez, Jesús Zacarías y Lavalle González, Fernando Javier y Maldonado Garza, Héctor Jesús y Bosques Padilla, Francisco Javier (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 Zacarías	NO ESPECIFICADO	orcid.org/0000-0002-6814-062X
Lavalle González, Fernando Javier	drfernandolavalle@hotmail.com	NO ESPECIFICADO
Maldonado Garza, Héctor Jesús	hectormaldonadog@yahoo.com	NO ESPECIFICADO
Bosques Padilla, Francisco Javier	fbosques58@hotmail.com	NO ESPECIFICADO