Adrenocortical dysfunction in liver disease: A systematic review

In patients with cirrhosis, adrenal insufficiency (AI) is reported during sepsis and septic shock and is associated with increased mortality. Consequently, the term “hepato‐adrenal syndrome” was proposed. Some studies have shown that AI is frequent in stable cirrhosis as well as in cirrhosis associa...

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Bibliographic Details
Published inHepatology (Baltimore, Md.) Vol. 55; no. 4; pp. 1282 - 1291
Main Authors Fede, Giuseppe, Spadaro, Luisa, Tomaselli, Tania, Privitera, Graziella, Germani, Giacomo, Tsochatzis, Emmanuel, Thomas, Michael, Bouloux, Pierre-Marc, Burroughs, Andrew K., Purrello, Francesco
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2012
Wiley
Wiley Subscription Services, Inc
Subjects
Adrenal Cortex - physiopathology
Adrenal Insufficiency - diagnosis
Adrenal Insufficiency - etiology
Adrenal Insufficiency - physiopathology
Adrenocorticotropic Hormone
Biological and medical sciences
Biomarkers - blood
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Hydrocortisone - blood
Liver Cirrhosis - complications
Liver Cirrhosis - physiopathology
Liver diseases
Liver Diseases - complications
Liver Diseases - physiopathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Dysfunction
Adrenal cortex
Gastroenterology
Digestive diseases
Hepatic disease
Review
Bibliographic review
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Summary:In patients with cirrhosis, adrenal insufficiency (AI) is reported during sepsis and septic shock and is associated with increased mortality. Consequently, the term “hepato‐adrenal syndrome” was proposed. Some studies have shown that AI is frequent in stable cirrhosis as well as in cirrhosis associated with decompensation other than sepsis, such as bleeding and ascites. Moreover, other studies showed a high prevalence in liver transplant recipients immediately after, or some time after, liver transplantation. The effect of corticosteroid therapy in critically ill patients with liver disease has been evaluated in some studies, but the results remain controversial. The 250‐μg adreno‐cortico‐tropic‐hormone stimulation test to diagnose AI in critically ill adult patients is recommended by an international task force. However, in liver disease, there is no consensus on the appropriate tests and normal values to assess adrenal function; thus, standardization of normal ranges and methodology is needed. Serum total cortisol assays overestimate AI in patients with cirrhosis, so that direct free cortisol measurement or its surrogates may be useful measurements to define AI, but further studies are needed to clarify this. In addition, the mechanisms by which liver disease leads to adrenal dysfunction are not sufficiently documented. This review evaluates published data regarding adrenal function in patients with liver disease, with a particular focus on the potential limitations of these studies as well as suggestions for future studies. (HEPATOLOGY 2012)
Bibliography:ark:/67375/WNG-S0X558R1-X
Potential conflict of interest: Nothing to report.
Abbreviations: ACTH, adreno-cortico-tropic-hormone; AI, adrenal insufficiency; ALF, acute liver failure; CBG, corticosteroid-binding globulin; CIRCI, critical illness-related corticosteroid insufficiency; CLD, chronic liver disease; CRH, corticotrophin-releasing hormone; FAGA, functional adrenal gland atrophy; FCI, free cortisol index; HDL, high-density lipoprotein; HPA, hypothalamus-pituitary-adrenal; ICU, intensive care unit; IIT, insulin-induced hypoglycemia test; IL, interleukin; IV, intravenously; LDL, low-density lipoprotein; LDSST, low-dose short Synacthen test; LT, liver transplant; MAP, mean arterial pressure; MELD, model for end-stage liver disease; PBC, primary biliary cirrhosis; RAI, relative adrenal insufficiency; RR, relative risk; SST, Short Synacthen test; TNF-a, tumor necrosis factor alpha.
istex:DB9B9A69FA1F284FBD5AA0C8F78B985F8899811B
ArticleID:HEP25573
These authors share senior authorship.
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Abbreviations: ACTH, adreno‐cortico‐tropic‐hormone; AI, adrenal insufficiency; ALF, acute liver failure; CBG, corticosteroid‐binding globulin; CIRCI, critical illness‐related corticosteroid insufficiency; CLD, chronic liver disease; CRH, corticotrophin‐releasing hormone; FAGA, functional adrenal gland atrophy; FCI, free cortisol index; HDL, high‐density lipoprotein; HPA, hypothalamus‐pituitary‐adrenal; ICU, intensive care unit; IIT, insulin‐induced hypoglycemia test; IL, interleukin; IV, intravenously; LDL, low‐density lipoprotein; LDSST, low‐dose short Synacthen test; LT, liver transplant; MAP, mean arterial pressure; MELD, model for end‐stage liver disease; PBC, primary biliary cirrhosis; RAI, relative adrenal insufficiency; RR, relative risk; SST, Short Synacthen test; TNF‐a, tumor necrosis factor alpha.
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ISSN:0270-9139
1527-3350
DOI:10.1002/hep.25573