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Cortisol metabolism in chronic liver disease
The Journal of Clinical Endocrinology and Metabolism
|June 1, 1975
Summary
Chronic liver disease alters cortisol metabolism, increasing unbound cortisol and potentially enhancing corticosteroid sensitivity. This suggests a need for reduced corticosteroid dosages in affected patients.
Area of Science:
- Endocrinology
- Hepatology
- Pharmacology
Background:
- Patients with chronic liver disease often exhibit impaired cortisol metabolism.
- Endogenous hypercortism and corticosteroid sensitivity are observed in these patients.
Purpose of the Study:
- To investigate adrenal function and cortisol metabolism in chronic liver disease patients.
- To correlate findings with endogenous hypercortism and corticosteroid sensitivity.
Main Methods:
- Measured plasma 11-hydroxycorticosteroids (11-OHCS) and urinary cortisol.
- Assessed corticosteroid binding globulin and cortisol secretion rate.
- Compared patient data with healthy control subjects.
Main Results:
- Lower mean plasma total 11-OHCS in patients, but normal circadian rhythm.
- Elevated non-protein bound 11-OHCS fraction due to impaired metabolism and reduced protein binding.
- Significantly reduced urinary cortisol and 17-ketosteroid excretion; normal cortisol secretion rate.
Conclusions:
- Elevated non-protein bound 11-OHCS in chronic liver disease may explain endogenous hypercorticism.
- Impaired steroid metabolism and protein binding suggest increased sensitivity to corticosteroids.
- Reduced corticosteroid dosage may be advisable for these patients.