Assessment of adrenal function in cirrhotic patients using concentration of serum-free and salivary cortisol

作者：Thevenot Thierry^*; Borot Sophie; Remy Martin Agnes; Sapin Remy; Cervoni Jean Paul; Richou Carine; Vanlemmens Claire; Cleau Denis; Muel Emilie; Minello Anne; Tirziu Simona; Penfornis Alfred; Di Martino Vincent; Monnet Elisabeth

来源：Liver International, 2011, 31(3): 425-433.

DOI：10.1111/j.1478-3231.2010.02431.x

• adrenal insufficiency
• cirrhosis
• cortisol
• sepsis

Objective
Because over 90% of serum cortisol is bound to albumin and corticosteroid-binding globulin (CBG), changes in these proteins can affect measures of serum total cortisol levels in cirrhotics without altering serum-free and salivary cortisol concentrations.
Methods
We assessed basal (T(0)) and post-synacthen (T(60)) serum total cortisol, serum-free and salivary cortisol in 125 consecutive cirrhotics (95 non-septic and 30 septic patients with a Child > 8).
Results
Serum total cortisol levels significantly decreased from the Child A-C non-septic group, as did albumin and CBG levels, with a non-significant rise in serum-free cortisol concentrations. Non-septic patients with low albumin (< 25 g/L) or CBG levels (< 35 mg/L) had lower T(0) serum total cortisol levels than patients with near-normal albumin (303.4 vs. 382.6 nmol/L; P=0.0035) or with normal CBG levels (289.9 vs. 441.4 nmol/L; P < 0.0001), respectively, despite similar serum-free cortisol or salivary cortisol concentrations. Subnormal T(60) serum total cortisol concentrations (< 510.4 nmol/L) were measured in 7.2% of all patients (Child C: 14.5% vs. Child A and B: 0%; P=0.0013) but no patients exhibited symptoms suggesting adrenal insufficiency. Patients with or without subnormal T(60) total cortisol had similar T(0) salivary cortisol and serum-free cortisol concentrations. A trend was observed towards high serum-free cortisol concentrations and mortality in multivariate analysis.
Conclusions
Serum total cortisol levels overestimated the prevalence of adrenal dysfunction in cirrhotics with end-stage liver disease. Since serum-free cortisol cannot be measured routinely, salivary cortisol testing could represent a useful approach but needs to be standardized.

• 出版日期2011-3