In patients with cirrhosis adrenal insufficiency (AI) is reported during sepsis and septic shock, and is associated with increased mortality. Consequently, the term "hepato-adrenal syndrome" was proposed. Some studies have shown that AI is frequent in stable cirrhosis, and in cirrhosis associated with decompensation other than sepsis, such as bleeding and ascites. Moreover, other studies showed a high prevalence in liver transplant recipients, immediately after or some time after liver transplantation. The effect of corticosteroid therapy in critically ill patients with liver disease has been evaluated in some studies, but the results remain controversial. The 250 µg ACTH stimulation test to diagnose AI in critically ill adult patients is recommended by an international task force. However in liver disease there is no consensus on the appropriate tests and normal values to assess adrenal function; thus standardization of normal ranges and methodology is needed. Serum total cortisol assays overestimate AI in patients with cirrhosis, so that direct free cortisol measurement or its surrogates may be useful measurements to define AI, but further studies are needed to clarify this. In addition, the mechanisms by which liver disease leads to adrenal dysfunction are not sufficiently documented. The review evaluates published data regarding adrenal function in patients with liver disease, with particular focus on the potential limitations of these studies, and suggestions for future studies. (HEPATOLOGY 2012.). Copyright © 2012 American Association for the Study of Liver Diseases.

Adrenocortical dysfunction in liver disease: A systematic review.

PURRELLO, Francesco
2012

Abstract

In patients with cirrhosis adrenal insufficiency (AI) is reported during sepsis and septic shock, and is associated with increased mortality. Consequently, the term "hepato-adrenal syndrome" was proposed. Some studies have shown that AI is frequent in stable cirrhosis, and in cirrhosis associated with decompensation other than sepsis, such as bleeding and ascites. Moreover, other studies showed a high prevalence in liver transplant recipients, immediately after or some time after liver transplantation. The effect of corticosteroid therapy in critically ill patients with liver disease has been evaluated in some studies, but the results remain controversial. The 250 µg ACTH stimulation test to diagnose AI in critically ill adult patients is recommended by an international task force. However in liver disease there is no consensus on the appropriate tests and normal values to assess adrenal function; thus standardization of normal ranges and methodology is needed. Serum total cortisol assays overestimate AI in patients with cirrhosis, so that direct free cortisol measurement or its surrogates may be useful measurements to define AI, but further studies are needed to clarify this. In addition, the mechanisms by which liver disease leads to adrenal dysfunction are not sufficiently documented. The review evaluates published data regarding adrenal function in patients with liver disease, with particular focus on the potential limitations of these studies, and suggestions for future studies. (HEPATOLOGY 2012.). Copyright © 2012 American Association for the Study of Liver Diseases.
Liver cirrhosis; adrenal insufficiency
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/69827
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