Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis

Area of Science:

• Endocrinology
• Hepatology
• Internal Medicine

Background:

• Adrenal insufficiency (AI) is a frequent complication in patients suffering from cirrhosis.
• Accurate diagnosis of AI is crucial for managing these patients.

Purpose of the Study:

• To evaluate the prevalence of AI in stable cirrhosis patients using the gold-standard insulin tolerance test (ITT).
• To develop and propose a screening algorithm for AI in this population.

Main Methods:

• A study involving 40 stable cirrhosis patients.
• Measurement of basal total cortisol (BTC) and peak cortisol (PTC) levels.
• Definition of AI based on PTC < 18 μg/dL post-ITT, and assessment of BTC diagnostic accuracy.

Main Results:

• 60% (24/40) of patients exhibited AI.
• AI patients had significantly higher Child-Pugh and MELD scores.
• Lower BTC levels were observed in AI patients (7.2 ± 2.4 μg/dL) compared to non-AI patients (12.5 ± 5.2 μg/dL).
• A BTC cutoff of ≤ 10.0 μg/dL demonstrated 96% sensitivity and 100% specificity for AI detection in advanced liver disease.

Conclusions:

• Basal total cortisol (BTC) measurement, combined with liver disease severity assessment, offers a practical and effective screening method for adrenal insufficiency in stable cirrhosis patients.
• The proposed algorithm can aid in simplifying the diagnostic process for AI in this vulnerable group.