LC : Evaluation of Adrenal Insufficiency in Cirrhotic Patients in Korea = LC : Evaluation of Adrenal Insufficiency in Cirrhotic Patients in Korea

다국어 초록 (Multilingual Abstract)

Background: Adrenal insufficiency (AI) is frequent in cirrhotic patients with severe infection or hemodynamic instability. However, there is limited data about the prevalence of AI in stable cirrhotic patients and the impact of etiology of cirrhosis on AI. This study prospectively evaluated prevalence and characteristic of AI in stable cirrhotic using the conventional short synacthen, a synthetic analogue of adrenocorticotrophic hormone. Methods: From July 2011 to Aug 2012, a total of 50 cirrhotic patients without infections or hemodynamic instability admitted to two university-affi liated hospitals were enrolled. AI was defined by a total serum cortisol level < 18 μg/dL at 30 or 60 min after injection of 250 μg of synacthen. Results: Thirty eight patients were men and age was ranged 29-89 years. Etiology of cirrhosis was alcohol/viral hepatitis/ both/others in 26/6/10/8 patients. AI was present in 18 patients (36%). No significant difference was observed regarding age, gender, mean arterial pressures, and heart rates between patients with and without AI. The etiology of cirrhosis and degree of alcohol consumption did not affect presence of AI or basal and peak serum cortisol levels either. Prothrombin time was higher, while albumin was lower in patients with AI than those without AI. However, in multivariate analysis, there was no independent predictor of AI. The prevalence of AI increased according to severity of liver disease (17, 50, and 33% in Child- Pugh class A, B, and C respectively; P=0.174). There were negative correlations between Child-Pugh score and both basal cortisol (γ=-.377, P=0.007) and peak cortisol levels (γ=-.373, P<0.005) Conclusions: In this study, AI was frequent in stable cirrhotic patients without infections or hemodynamic instability. AI was not related to the etiology of cirrhosis or alcohol consumption, either. AI tended to be associated with only severity of liver disease.