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Thai Journal of Gastroenterology
2007 Vol.8 No.3
Article :
The Adrenal Insufficiency and Cortisol Response after ACTH
Stimulation Test in Non-highly Stressed Patients with Cirrhosis |
Author :
Sanpajit T,M.D.
Chutaputti A,M.D. |
Abstract :
Objective:
Adrenal insufficiency is common in critically ill patients,particularly those with septic shock. Patient with liver failure and sepsis shared many clinical features,including hyperdynamic circulation.In critically ill patients,adrenal insufficiency is associated with hemodynamic instability and poor outcome.This study exam-ined the functional adrenal reserve by using ACTH stimulation test in fifteen non-highly stressed patients with cirrhosis.
Patients and Methods:
A low-dose (1 µg)ACTH (corticotropin)test was done in non-highly stressed patients with cirrhosis who were admitted due to various causes within 5 days of admission.
Results:
The result of ACTH stimulation test of fifteen patients revealed that 6/15 (40%)patients were classified as adrenal insufficiency reserve and 9/15 (60%)were indicated as normal adrenal function.Among those with impaired adrenal reserves five of six patients displayed basal and stimulated cortisol values of lower than 20 µg/dL.The LDL-cholesterol level at the time of adrenal testing was the variable predictive of adrenal insufficiency (p =0.035). The baseline basal cortisol were 16.4 5.5 in the Child--Pugh score A and B compared with 19.1 6.5 in the Child-Pugh score C (p =0.4).The peak serum cortisol were 22.7 4.0 in the Child-Pugh score A and B compared with 21.4 4.0 in the Child-Pugh score C (p =0.69).The increment in cortisol levels in the Child-Pugh score A and B (6.4 2.5 µg/dL)was significantly higher than in the Child-Pugh score C (2.3 1.8 µg/dL)(p = 0.003)
Conclusions:
Adrenal insufficiency assessed by the ACTH stimulation test is common in non-highly stressed patients with cirrhosis.It is more frequent in those with severe liver disease. |
Keyword :
Adrenal insufficiency,Cirrhosis,Lipoproteins
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file/Thai-Journal-of-gastroenterology-vol-8-no-3-4676291.pdf