Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis
Purpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) co...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2019/7251010 |
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| author | Lara Albert Joaquím Profitós Jordi Sánchez-Delgado Ismael Capel José Miguel González-Clemente David Subías Albert Cano Eugenio Berlanga Anna Espinal Marta Hurtado Rocío Pareja Mercedes Rigla Blai Dalmau Mercedes Vergara Mireia Miquel Meritxell Casas Olga Giménez-Palop |
| author_facet | Lara Albert Joaquím Profitós Jordi Sánchez-Delgado Ismael Capel José Miguel González-Clemente David Subías Albert Cano Eugenio Berlanga Anna Espinal Marta Hurtado Rocío Pareja Mercedes Rigla Blai Dalmau Mercedes Vergara Mireia Miquel Meritxell Casas Olga Giménez-Palop |
| author_sort | Lara Albert |
| collection | DOAJ |
| description | Purpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. Methods. We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0’(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30’(T30), 60’(T60), and 90’(T90)]. Results. Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0< 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dl (39.5 nmol/L), or ΔSaC<1 μg/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T0< 9 μg/dl [248 nmol/L], TSC-T60 < 18 μg/dl [497 nmol/L], or ΔTSC<9 μg/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification. Conclusions. Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients. |
| format | Article |
| id | doaj-art-e5b57baca2274f8c8bd0782e1d79261b |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Endocrinology |
| spelling | doaj-art-e5b57baca2274f8c8bd0782e1d79261b2025-02-03T06:42:29ZengWileyInternational Journal of Endocrinology1687-83371687-83452019-01-01201910.1155/2019/72510107251010Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver CirrhosisLara Albert0Joaquím Profitós1Jordi Sánchez-Delgado2Ismael Capel3José Miguel González-Clemente4David Subías5Albert Cano6Eugenio Berlanga7Anna Espinal8Marta Hurtado9Rocío Pareja10Mercedes Rigla11Blai Dalmau12Mercedes Vergara13Mireia Miquel14Meritxell Casas15Olga Giménez-Palop16Endocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainClinical Laboratory Department, Institut d’Investigació i Innovació Parc Taulí I3PT, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell, SpainServei d’Estadística Aplicada, Universitat Autònoma de Barcelona, Bellaterra, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainLiver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainEndocrinology Department, Parc Taulí University Hospital, Institut d’Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, SpainPurpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. Methods. We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0’(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30’(T30), 60’(T60), and 90’(T90)]. Results. Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0< 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dl (39.5 nmol/L), or ΔSaC<1 μg/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T0< 9 μg/dl [248 nmol/L], TSC-T60 < 18 μg/dl [497 nmol/L], or ΔTSC<9 μg/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification. Conclusions. Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients.http://dx.doi.org/10.1155/2019/7251010 |
| spellingShingle | Lara Albert Joaquím Profitós Jordi Sánchez-Delgado Ismael Capel José Miguel González-Clemente David Subías Albert Cano Eugenio Berlanga Anna Espinal Marta Hurtado Rocío Pareja Mercedes Rigla Blai Dalmau Mercedes Vergara Mireia Miquel Meritxell Casas Olga Giménez-Palop Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis International Journal of Endocrinology |
| title | Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis |
| title_full | Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis |
| title_fullStr | Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis |
| title_full_unstemmed | Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis |
| title_short | Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis |
| title_sort | salivary cortisol determination in acth stimulation test to diagnose adrenal insufficiency in patients with liver cirrhosis |
| url | http://dx.doi.org/10.1155/2019/7251010 |
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