| Critical illness-related corticosteroid insufficiency in patients with cirrhosis and variceal bleeding. | |
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MedLine Citation:
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PMID: 21545846 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND & AIMS: Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. METHODS: Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤ 18 μg/dL in nonstressed patients or Δmax <9 μg/dL or a total cortisol level <10 μg/dL in stressed patients with variceal bleeding-the current criteria for critical illness-related corticosteroid insufficiency. Using LDSST, diagnosis was based on peak concentrations of cortisol ≤ 18 μg/dL in nonstressed patients and <25 μg/dL (or Δmax <9 μg/dL) in patients with variceal bleeding. We evaluated patients with levels of serum albumin >2.5 g/dL, to indirectly assess cortisol binding. RESULTS: All healthy volunteers had normal results from LDSSTs and SSTs. Patients with variceal bleeding had higher median baseline concentrations of cortisol (15.4 μg/dL) than stable cirrhotic patients (8.7 μg/dL, P = .001) or healthy volunteers (10.1 μg/dL, P = .01). Patients with variceal bleeding had higher median peak concentrations of cortisol than stable cirrhotic patients (SST results of 32.7 vs 21 μg/dL, P = .001; LDSST results of 9.3 vs 8.1 μg/dL; nonsignificant), with no differences in Δmax in either test. These differences were greater with variceal bleeding than in stable cirrhotic patients with AI. Subanalysis of patients with albumin levels >2.5 g/dL did not change these differences. CONCLUSIONS: Cirrhotic patients with variceal bleeding have AI. Despite higher baseline concentrations of serum cortisol and subnormal Δmax values, they did not have adequate responses to stress, and therefore had critical illness-related corticosteroid insufficiency. |
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Authors:
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Christos K Triantos; Michel Marzigie; Giuseppe Fede; Marina Michalaki; Dimitra Giannakopoulou; Konstantinos Thomopoulos; Matteo Garcovich; Maria Kalafateli; Aris Chronis; Venetsana Kyriazopoulou; Eleni Jelastopoulou; Vasiliki Nikolopoulou; James O'Beirne; Andrew K Burroughs |
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Publication Detail:
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Type: Journal Article Date: 2011-04-08 |
Journal Detail:
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Title: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Volume: 9 ISSN: 1542-7714 ISO Abbreviation: Clin. Gastroenterol. Hepatol. Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-06-24 Completed Date: 2011-10-13 Revised Date: 2012-01-26 |
Medline Journal Info:
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Nlm Unique ID: 101160775 Medline TA: Clin Gastroenterol Hepatol Country: United States |
Other Details:
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Languages: eng Pagination: 595-601 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Gastroenterology, University Hospital of Patras, Patras, Greece. chtriantos@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Cortex Hormones
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deficiency* Adult Aged Critical Illness* Female Gastrointestinal Hemorrhage / complications* Humans Hydrocortisone / blood Liver Cirrhosis / complications* Male Middle Aged |
| Chemical | |
Reg. No./Substance:
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0/Adrenal Cortex Hormones; 50-23-7/Hydrocortisone |
| Comments/Corrections | |
Comment In:
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Clin Gastroenterol Hepatol. 2012 Jan;10(1):95; author reply 95
[PMID:
21888881
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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