Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding
Background & Aims Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods Twenty cirrhotic patients with variceal bleeding were evaluated using the sh...
Gespeichert in:
| Veröffentlicht in: | Clinical gastroenterology and hepatology 2011-07, Vol.9 (7), p.595-601 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 601 |
|---|---|
| container_issue | 7 |
| container_start_page | 595 |
| container_title | Clinical gastroenterology and hepatology |
| container_volume | 9 |
| creator | Triantos, Christos K Marzigie, Michel Fede, Giuseppe Michalaki, Marina Giannakopoulou, Dimitra Thomopoulos, Konstantinos Garcovich, Matteo Kalafateli, Maria Chronis, Aris Kyriazopoulou, Venetsana Jelastopoulou, Eleni Nikolopoulou, Vasiliki O'Beirne, James Burroughs, Andrew K |
| description | Background & Aims Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤18 μg/dL in nonstressed patients or Δmax |
| doi_str_mv | 10.1016/j.cgh.2011.03.033 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_873704492</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1542356511003429</els_id><sourcerecordid>873704492</sourcerecordid><originalsourceid>FETCH-LOGICAL-c450t-40aae0a670ae9439ab0985b8063bce1f6b7d64aff0d3da3b1e208aba891d12cf3</originalsourceid><addsrcrecordid>eNp9kVuLFDEQhYMo7rr6A3yRfvOpx8qlbwiCNl4GFhSvjyGdVHYyZrrXVLcw_960M_rgg1CQgjrnQL7D2GMOGw68frbf2JvdRgDnG5B55B12ySslyqbh6u55l1VdXbAHRHsA0amuuc8uRL5Uraovme9TmIM1sdjGOCJR-RGjmdEV_ZTyYaIZ0xRcsR1p8T7YgKM9FmEsPpg57zMV38K8K_qQ0m6iQIUZXfHVpGAxh76KiC6MNw_ZPW8i4aPze8W-vHn9uX9XXr9_u-1fXpdWVTCXCoxBMHUDBjslOzNA11ZDC7UcLHJfD42rlfEenHRGDhwFtGYwbccdF9bLK_b0lHubph8L0qwPgSzGaEacFtJtIxtQqhNZyU9KmyaihF7fpnAw6ag56JWu3utMV690Ncg8MnuenNOX4YDur-MPzix4fhJg_uPPgEnTb2CZQUI7azeF_8a_-MdtYxjXcr7jEWk_LWnM8DTXJDToT2u9a7ucA0glOvkLBhCg0g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>873704492</pqid></control><display><type>article</type><title>Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Triantos, Christos K ; Marzigie, Michel ; Fede, Giuseppe ; Michalaki, Marina ; Giannakopoulou, Dimitra ; Thomopoulos, Konstantinos ; Garcovich, Matteo ; Kalafateli, Maria ; Chronis, Aris ; Kyriazopoulou, Venetsana ; Jelastopoulou, Eleni ; Nikolopoulou, Vasiliki ; O'Beirne, James ; Burroughs, Andrew K</creator><creatorcontrib>Triantos, Christos K ; Marzigie, Michel ; Fede, Giuseppe ; Michalaki, Marina ; Giannakopoulou, Dimitra ; Thomopoulos, Konstantinos ; Garcovich, Matteo ; Kalafateli, Maria ; Chronis, Aris ; Kyriazopoulou, Venetsana ; Jelastopoulou, Eleni ; Nikolopoulou, Vasiliki ; O'Beirne, James ; Burroughs, Andrew K</creatorcontrib><description>Background & Aims Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤18 μg/dL in nonstressed patients or Δmax <9 μg/dL or a total cortisol level <10 μg/dL in stressed patients with variceal bleeding—the current criteria for critical illness-related corticosteroid insufficiency. Using LDSST, diagnosis was based on peak concentrations of cortisol ≤18 μg/dL in nonstressed patients and <25 μg/dL (or Δmax <9 μg/dL) in patients with variceal bleeding. We evaluated patients with levels of serum albumin >2.5 g/dL, to indirectly assess cortisol binding. Results All healthy volunteers had normal results from LDSSTs and SSTs. Patients with variceal bleeding had higher median baseline concentrations of cortisol (15.4 μg/dL) than stable cirrhotic patients (8.7 μg/dL, P = .001) or healthy volunteers (10.1 μg/dL, P = .01). Patients with variceal bleeding had higher median peak concentrations of cortisol than stable cirrhotic patients (SST results of 32.7 vs 21 μg/dL, P = .001; LDSST results of 9.3 vs 8.1 μg/dL; nonsignificant), with no differences in Δmax in either test. These differences were greater with variceal bleeding than in stable cirrhotic patients with AI. Subanalysis of patients with albumin levels >2.5 g/dL did not change these differences. Conclusions Cirrhotic patients with variceal bleeding have AI. Despite higher baseline concentrations of serum cortisol and subnormal Δmax values, they did not have adequate responses to stress, and therefore had critical illness-related corticosteroid insufficiency.</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2011.03.033</identifier><identifier>PMID: 21545846</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenal Cortex Hormones - deficiency ; Adult ; Aged ; Critical Illness ; Female ; Gastroenterology and Hepatology ; Gastrointestinal Hemorrhage - complications ; Humans ; Hydrocortisone - blood ; Liver Cirrhosis - complications ; Liver Disease ; Male ; Middle Aged ; Pituitary ; Stress ; Varices</subject><ispartof>Clinical gastroenterology and hepatology, 2011-07, Vol.9 (7), p.595-601</ispartof><rights>AGA Institute</rights><rights>2011 AGA Institute</rights><rights>Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-40aae0a670ae9439ab0985b8063bce1f6b7d64aff0d3da3b1e208aba891d12cf3</citedby><cites>FETCH-LOGICAL-c450t-40aae0a670ae9439ab0985b8063bce1f6b7d64aff0d3da3b1e208aba891d12cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1542356511003429$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21545846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Triantos, Christos K</creatorcontrib><creatorcontrib>Marzigie, Michel</creatorcontrib><creatorcontrib>Fede, Giuseppe</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Giannakopoulou, Dimitra</creatorcontrib><creatorcontrib>Thomopoulos, Konstantinos</creatorcontrib><creatorcontrib>Garcovich, Matteo</creatorcontrib><creatorcontrib>Kalafateli, Maria</creatorcontrib><creatorcontrib>Chronis, Aris</creatorcontrib><creatorcontrib>Kyriazopoulou, Venetsana</creatorcontrib><creatorcontrib>Jelastopoulou, Eleni</creatorcontrib><creatorcontrib>Nikolopoulou, Vasiliki</creatorcontrib><creatorcontrib>O'Beirne, James</creatorcontrib><creatorcontrib>Burroughs, Andrew K</creatorcontrib><title>Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>Background & Aims Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤18 μg/dL in nonstressed patients or Δmax <9 μg/dL or a total cortisol level <10 μg/dL in stressed patients with variceal bleeding—the current criteria for critical illness-related corticosteroid insufficiency. Using LDSST, diagnosis was based on peak concentrations of cortisol ≤18 μg/dL in nonstressed patients and <25 μg/dL (or Δmax <9 μg/dL) in patients with variceal bleeding. We evaluated patients with levels of serum albumin >2.5 g/dL, to indirectly assess cortisol binding. Results All healthy volunteers had normal results from LDSSTs and SSTs. Patients with variceal bleeding had higher median baseline concentrations of cortisol (15.4 μg/dL) than stable cirrhotic patients (8.7 μg/dL, P = .001) or healthy volunteers (10.1 μg/dL, P = .01). Patients with variceal bleeding had higher median peak concentrations of cortisol than stable cirrhotic patients (SST results of 32.7 vs 21 μg/dL, P = .001; LDSST results of 9.3 vs 8.1 μg/dL; nonsignificant), with no differences in Δmax in either test. These differences were greater with variceal bleeding than in stable cirrhotic patients with AI. Subanalysis of patients with albumin levels >2.5 g/dL did not change these differences. Conclusions Cirrhotic patients with variceal bleeding have AI. Despite higher baseline concentrations of serum cortisol and subnormal Δmax values, they did not have adequate responses to stress, and therefore had critical illness-related corticosteroid insufficiency.</description><subject>Adrenal Cortex Hormones - deficiency</subject><subject>Adult</subject><subject>Aged</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastrointestinal Hemorrhage - complications</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Disease</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pituitary</subject><subject>Stress</subject><subject>Varices</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVuLFDEQhYMo7rr6A3yRfvOpx8qlbwiCNl4GFhSvjyGdVHYyZrrXVLcw_960M_rgg1CQgjrnQL7D2GMOGw68frbf2JvdRgDnG5B55B12ySslyqbh6u55l1VdXbAHRHsA0amuuc8uRL5Uraovme9TmIM1sdjGOCJR-RGjmdEV_ZTyYaIZ0xRcsR1p8T7YgKM9FmEsPpg57zMV38K8K_qQ0m6iQIUZXfHVpGAxh76KiC6MNw_ZPW8i4aPze8W-vHn9uX9XXr9_u-1fXpdWVTCXCoxBMHUDBjslOzNA11ZDC7UcLHJfD42rlfEenHRGDhwFtGYwbccdF9bLK_b0lHubph8L0qwPgSzGaEacFtJtIxtQqhNZyU9KmyaihF7fpnAw6ag56JWu3utMV690Ncg8MnuenNOX4YDur-MPzix4fhJg_uPPgEnTb2CZQUI7azeF_8a_-MdtYxjXcr7jEWk_LWnM8DTXJDToT2u9a7ucA0glOvkLBhCg0g</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Triantos, Christos K</creator><creator>Marzigie, Michel</creator><creator>Fede, Giuseppe</creator><creator>Michalaki, Marina</creator><creator>Giannakopoulou, Dimitra</creator><creator>Thomopoulos, Konstantinos</creator><creator>Garcovich, Matteo</creator><creator>Kalafateli, Maria</creator><creator>Chronis, Aris</creator><creator>Kyriazopoulou, Venetsana</creator><creator>Jelastopoulou, Eleni</creator><creator>Nikolopoulou, Vasiliki</creator><creator>O'Beirne, James</creator><creator>Burroughs, Andrew K</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110701</creationdate><title>Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding</title><author>Triantos, Christos K ; Marzigie, Michel ; Fede, Giuseppe ; Michalaki, Marina ; Giannakopoulou, Dimitra ; Thomopoulos, Konstantinos ; Garcovich, Matteo ; Kalafateli, Maria ; Chronis, Aris ; Kyriazopoulou, Venetsana ; Jelastopoulou, Eleni ; Nikolopoulou, Vasiliki ; O'Beirne, James ; Burroughs, Andrew K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-40aae0a670ae9439ab0985b8063bce1f6b7d64aff0d3da3b1e208aba891d12cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adrenal Cortex Hormones - deficiency</topic><topic>Adult</topic><topic>Aged</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastrointestinal Hemorrhage - complications</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Disease</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pituitary</topic><topic>Stress</topic><topic>Varices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Triantos, Christos K</creatorcontrib><creatorcontrib>Marzigie, Michel</creatorcontrib><creatorcontrib>Fede, Giuseppe</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Giannakopoulou, Dimitra</creatorcontrib><creatorcontrib>Thomopoulos, Konstantinos</creatorcontrib><creatorcontrib>Garcovich, Matteo</creatorcontrib><creatorcontrib>Kalafateli, Maria</creatorcontrib><creatorcontrib>Chronis, Aris</creatorcontrib><creatorcontrib>Kyriazopoulou, Venetsana</creatorcontrib><creatorcontrib>Jelastopoulou, Eleni</creatorcontrib><creatorcontrib>Nikolopoulou, Vasiliki</creatorcontrib><creatorcontrib>O'Beirne, James</creatorcontrib><creatorcontrib>Burroughs, Andrew K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Triantos, Christos K</au><au>Marzigie, Michel</au><au>Fede, Giuseppe</au><au>Michalaki, Marina</au><au>Giannakopoulou, Dimitra</au><au>Thomopoulos, Konstantinos</au><au>Garcovich, Matteo</au><au>Kalafateli, Maria</au><au>Chronis, Aris</au><au>Kyriazopoulou, Venetsana</au><au>Jelastopoulou, Eleni</au><au>Nikolopoulou, Vasiliki</au><au>O'Beirne, James</au><au>Burroughs, Andrew K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2011-07-01</date><risdate>2011</risdate><volume>9</volume><issue>7</issue><spage>595</spage><epage>601</epage><pages>595-601</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>Background & Aims Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤18 μg/dL in nonstressed patients or Δmax <9 μg/dL or a total cortisol level <10 μg/dL in stressed patients with variceal bleeding—the current criteria for critical illness-related corticosteroid insufficiency. Using LDSST, diagnosis was based on peak concentrations of cortisol ≤18 μg/dL in nonstressed patients and <25 μg/dL (or Δmax <9 μg/dL) in patients with variceal bleeding. We evaluated patients with levels of serum albumin >2.5 g/dL, to indirectly assess cortisol binding. Results All healthy volunteers had normal results from LDSSTs and SSTs. Patients with variceal bleeding had higher median baseline concentrations of cortisol (15.4 μg/dL) than stable cirrhotic patients (8.7 μg/dL, P = .001) or healthy volunteers (10.1 μg/dL, P = .01). Patients with variceal bleeding had higher median peak concentrations of cortisol than stable cirrhotic patients (SST results of 32.7 vs 21 μg/dL, P = .001; LDSST results of 9.3 vs 8.1 μg/dL; nonsignificant), with no differences in Δmax in either test. These differences were greater with variceal bleeding than in stable cirrhotic patients with AI. Subanalysis of patients with albumin levels >2.5 g/dL did not change these differences. Conclusions Cirrhotic patients with variceal bleeding have AI. Despite higher baseline concentrations of serum cortisol and subnormal Δmax values, they did not have adequate responses to stress, and therefore had critical illness-related corticosteroid insufficiency.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21545846</pmid><doi>10.1016/j.cgh.2011.03.033</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1542-3565 |
| ispartof | Clinical gastroenterology and hepatology, 2011-07, Vol.9 (7), p.595-601 |
| issn | 1542-3565 1542-7714 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_873704492 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adrenal Cortex Hormones - deficiency Adult Aged Critical Illness Female Gastroenterology and Hepatology Gastrointestinal Hemorrhage - complications Humans Hydrocortisone - blood Liver Cirrhosis - complications Liver Disease Male Middle Aged Pituitary Stress Varices |
| title | Critical Illness-Related Corticosteroid Insufficiency in Patients With Cirrhosis and Variceal Bleeding |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T12%3A20%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Critical%20Illness-Related%20Corticosteroid%20Insufficiency%20in%20Patients%20With%20Cirrhosis%20and%20Variceal%20Bleeding&rft.jtitle=Clinical%20gastroenterology%20and%20hepatology&rft.au=Triantos,%20Christos%20K&rft.date=2011-07-01&rft.volume=9&rft.issue=7&rft.spage=595&rft.epage=601&rft.pages=595-601&rft.issn=1542-3565&rft.eissn=1542-7714&rft_id=info:doi/10.1016/j.cgh.2011.03.033&rft_dat=%3Cproquest_cross%3E873704492%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=873704492&rft_id=info:pmid/21545846&rft_els_id=1_s2_0_S1542356511003429&rfr_iscdi=true |