Assessment of adrenal function in cirrhotic patients using concentration of serum‐free and salivary cortisol |
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| Authors: | Thierry Thevenot Sophie Borot Agnès Remy‐Martin Remy Sapin Jean‐Paul Cervoni Carine Richou Claire Vanlemmens Denis Cleau Emilie Muel Anne Minello Simona Tirziu Alfred Penfornis Vincent Di Martino Elisabeth Monnet |
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| Affiliation: | 1. Service d'Hépatologie et de Soins Intensifs Digestifs, H?pital Jean Minjoz, Besan?on cedex, France;2. EA UPRES 3186, ‘Agents Pathogènes et Inflammation’, de l'Université de Franche‐Comté, Besan?on cedex, France;3. Service d'Endocrinologie‐Métabolisme et Diabétologie‐Nutrition, H?pital Jean Minjoz, Besan?on cedex, France;4. Service de Biochimie Hormonale, H?pital Jean Minjoz, Besan?on cedex, France;5. Service d'Exploration Fonctionnelle par les Isotopes, 1 place de l'H?pital, H?pital civil de Strasbourg, Strasbourg Cedex, France;6. Service d'Hépato‐gastroentérologie, H?pital de Vesoul, Vesoul Cedex, France;7. Centre d'Investigation Clinique, H?pital Saint Jacques, Besan?on cedex, France;8. Service d'Hépato‐gastroentérologie, H?pital du Bocage, Dijon Cedex, France |
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| Abstract: | Objective: Because over 90% of serum cortisol is bound to albumin and corticosteroid‐binding globulin (CBG), changes in these proteins can affect measures of serum total cortisol levels in cirrhotics without altering serum‐free and salivary cortisol concentrations. Methods: We assessed basal (T0) and post‐synacthen (T60) serum total cortisol, serum‐free and salivary cortisol in 125 consecutive cirrhotics (95 non‐septic and 30 septic patients with a Child>8). Results: Serum total cortisol levels significantly decreased from the Child A–C non‐septic group, as did albumin and CBG levels, with a non‐significant rise in serum‐free cortisol concentrations. Non‐septic patients with low albumin (≤25 g/L) or CBG levels (≤35 mg/L) had lower T0 serum total cortisol levels than patients with near‐normal albumin (303.4 vs. 382.6 nmol/L; P=0.0035) or with normal CBG levels (289.9 vs. 441.4 nmol/L; P<0.0001), respectively, despite similar serum‐free cortisol or salivary cortisol concentrations. Subnormal T60 serum total cortisol concentrations (<510.4 nmol/L) were measured in 7.2% of all patients (Child C: 14.5% vs. Child A and B: 0%; P=0.0013) but no patients exhibited symptoms suggesting adrenal insufficiency. Patients with or without subnormal T60 total cortisol had similar T0 salivary cortisol and serum‐free cortisol concentrations. A trend was observed towards high serum‐free cortisol concentrations and mortality in multivariate analysis. Conclusions: Serum total cortisol levels overestimated the prevalence of adrenal dysfunction in cirrhotics with end‐stage liver disease. Since serum‐free cortisol cannot be measured routinely, salivary cortisol testing could represent a useful approach but needs to be standardized. |
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| Keywords: | adrenal insufficiency cirrhosis cortisol sepsis |
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