Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis
Introduction and aims. AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. Material and methods. We studied 40 stabl Mate...
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| Formato: | Artículo |
| Lenguaje: | inglés |
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Ediciones Medicina y Cultura
2017
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| Materias: | |
| Acceso en línea: | http://eprints.uanl.mx/27875/1/532.pdf |
| _version_ | 1838551015073251328 |
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| author | Paz Delgadillo, Jonathan Monreal Robles, Roberto Villarreal Pérez, Jesús Zacarías Lavalle González, Fernando Javier Maldonado Garza, Héctor Jesús Bosques Padilla, Francisco Javier |
| author_facet | Paz Delgadillo, Jonathan Monreal Robles, Roberto Villarreal Pérez, Jesús Zacarías Lavalle González, Fernando Javier Maldonado Garza, Héctor Jesús Bosques Padilla, Francisco Javier |
| author_sort | Paz Delgadillo, Jonathan |
| collection | Repositorio Institucional |
| description | Introduction and aims. AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. Material and methods. We studied 40 stabl Material and methods. e patients with cirrhosis. We determined the basal total (BTC) and
peak cortisol (PTC) levels. Using the ITT, we defined AI as a serum PTC < 18 Pg/dL at 30 min after insulin-induced hypoglycemia. We assessed the diagnostic accuracy of BTC in different stages of liver disease to discriminate between those with NAF and AI.
Results. Of the 40 patients, 24 (60%) presented with AI. Child-Pugh and MELD scores differed between the NAF and AI groups Results. (Child-Pugh: NAF 7.2 r 1.7 vs. AI 8.8 r 2.4, p = 0.024 and MELD: NAF 9.9 r 2.5 vs. AI 14.9 r 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 r 2.4 vs. 12.5 r 5.2, p < 0.001). A BTC value d 10.0 Pg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC d 10.0 Pg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh t 9 or MELD t 12). Conclusion. An algorithm in- Conclusion. cluding the use of BTC and the severity of liver disease may be a useful and simple method for assessing adrenal function in stable patients with cirrhosis. |
| format | Article |
| id | eprints-27875 |
| institution | UANL |
| language | English |
| publishDate | 2017 |
| publisher | Ediciones Medicina y Cultura |
| record_format | eprints |
| spelling | eprints-278752025-07-23T15:39:51Z http://eprints.uanl.mx/27875/ Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis Paz Delgadillo, Jonathan Monreal Robles, Roberto Villarreal Pérez, Jesús Zacarías Lavalle González, Fernando Javier Maldonado Garza, Héctor Jesús Bosques Padilla, Francisco Javier RC Medicina Interna, Psiquiatría, Neurología Introduction and aims. AI) is common in patients with cirrhosis. We aimed to assess the presence of AI in stable patients with cirrhosis using the gold-standard insulin tolerance test (ITT) and to propose an algorithm for screening AI in these patients. Material and methods. We studied 40 stabl Material and methods. e patients with cirrhosis. We determined the basal total (BTC) and peak cortisol (PTC) levels. Using the ITT, we defined AI as a serum PTC < 18 Pg/dL at 30 min after insulin-induced hypoglycemia. We assessed the diagnostic accuracy of BTC in different stages of liver disease to discriminate between those with NAF and AI. Results. Of the 40 patients, 24 (60%) presented with AI. Child-Pugh and MELD scores differed between the NAF and AI groups Results. (Child-Pugh: NAF 7.2 r 1.7 vs. AI 8.8 r 2.4, p = 0.024 and MELD: NAF 9.9 r 2.5 vs. AI 14.9 r 6.3, p = 0.001). The BTC level was lower in patients with AI than in those with NAF (7.2 r 2.4 vs. 12.5 r 5.2, p < 0.001). A BTC value d 10.0 Pg/dL had a 96% sensitivity (negative predictive value: 90%) for identifying AI. This cutoff value (BTC d 10.0 Pg/dL) provided 100% specificity (positive predictive value: 100%) in patients with advanced liver disease (Child-Pugh t 9 or MELD t 12). Conclusion. An algorithm in- Conclusion. cluding the use of BTC and the severity of liver disease may be a useful and simple method for assessing adrenal function in stable patients with cirrhosis. Ediciones Medicina y Cultura 2017 Article PeerReviewed text en cc_by_nc_nd http://eprints.uanl.mx/27875/1/532.pdf http://eprints.uanl.mx/27875/1.haspreviewThumbnailVersion/532.pdf Paz Delgadillo, Jonathan y Monreal Robles, Roberto y Villarreal Pérez, Jesús Zacarías y Lavalle González, Fernando Javier y Maldonado Garza, Héctor Jesús y Bosques Padilla, Francisco Javier (2017) Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis. Annals of Hepatology, 16 (5). pp. 788-796. ISSN 16652681 http://doi.org/10.5604/01.3001.0010.2797 doi:10.5604/01.3001.0010.2797 |
| spellingShingle | RC Medicina Interna, Psiquiatría, Neurología Paz Delgadillo, Jonathan Monreal Robles, Roberto Villarreal Pérez, Jesús Zacarías Lavalle González, Fernando Javier Maldonado Garza, Héctor Jesús Bosques Padilla, Francisco Javier Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| thumbnail | https://rediab.uanl.mx/themes/sandal5/images/online.png |
| title | Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| title_full | Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| title_fullStr | Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| title_full_unstemmed | Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| title_short | Algorithm for Screening of Adrenal Function in Stable Patients with Cirrhosis |
| title_sort | algorithm for screening of adrenal function in stable patients with cirrhosis |
| topic | RC Medicina Interna, Psiquiatría, Neurología |
| url | http://eprints.uanl.mx/27875/1/532.pdf |
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