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Hypothalamic-pituitary adrenal function in end-stage non-alcoholic liver disease
J A McDonald1, D J Handelsman, P Dilworth
1A. W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Journal of Gastroenterology and Hepatology
|May 1, 1993
Summary
Patients with severe liver disease exhibit impaired adrenal function, increasing mortality risk. This study found reduced cortisol responses to adrenal stimulation in liver disease patients compared to controls.
Area of Science:
- Endocrinology
- Hepatology
- Internal Medicine
Background:
- End-stage liver disease (ESLD) patients face high mortality, often due to bleeding or sepsis.
- Adequate adrenal function is critical for managing critical illness in ESLD.
- The presence of adrenal insufficiency in severe liver disease requires further investigation.
Purpose of the Study:
- To evaluate hypothalamic-pituitary adrenal function in patients with end-stage liver disease awaiting transplantation.
- To test the hypothesis that adrenal insufficiency is present in severe, non-alcoholic liver disease.
- To correlate adrenal function with liver disease severity.
Main Methods:
- Prospective, open comparative study of 38 ESLD patients and 40 healthy controls.
- Exclusion of patients using corticosteroids or unable to complete tests.
- Assessment of basal and stimulated adrenal function using insulin-induced hypoglycemia and ACTH stimulation tests, measuring plasma cortisol, corticosteroid-binding globulin, and dehydroepiandrosterone sulfate.
Main Results:
- ESLD patients showed significantly reduced maximal plasma cortisol increments: 64% to insulin-induced hypoglycemia and 39% to ACTH stimulation (P < 0.001).
- A significant negative correlation was observed between Child-Pugh scores and peak cortisol responses to both ACTH (r = -0.647) and insulin-induced hypoglycemia (r = -0.597) (P < 0.0001).
Conclusions:
- Patients with end-stage liver disease demonstrate impaired adrenal function.
- Adrenal insufficiency is linked to the severity of liver disease.
- These findings highlight the importance of assessing adrenal function in ESLD patients.