Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2024-02-18 DOI:10.1111/cen.15030

Vijayakumar Karthik, Puthiyaveetil Khadar Jabbar, Devadas Krishnadas, Abilash Nair, Geena Susan George, Chellamma Jayakumari, Sarayu Soumya, Arsha Asok, Shameer Basheer

{"title":"Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver","authors":"Vijayakumar Karthik, Puthiyaveetil Khadar Jabbar, Devadas Krishnadas, Abilash Nair, Geena Susan George, Chellamma Jayakumari, Sarayu Soumya, Arsha Asok, Shameer Basheer","doi":"10.1111/cen.15030","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>There are no reliable methods in clinical practice to diagnose adrenal insufficiency (AI) in patients with cirrhosis owing to variable cortisol-binding protein levels. This leads to unreliable results in ACTH stimulated serum cortisol test. We aimed to estimate the long-acting porcine (LA)ACTH-stimulated serum and salivary cortisol levels of patients at different stages of cirrhosis using second generation electrochemiluminescence and to determine the prevalence of true adrenal insufficiency in these patients.</p>\n </section>\n \n <section>\n \n <h3> Design, Patients and Measurements</h3>\n \n <p>We included 135 noncritical patients with cirrhosis (45 each from CHILD A, B and C) and 45 healthy controls. Serum and salivary samples were collected at baseline in the morning and at 1 and 2 h after LA-ACTH injection.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In healthy subjects, the 2.5th centile of 2 h ACTH stimulated serum and salivary cortisol were 19.8 and 0.97 μg/dL, which were used as cut-offs for defining AI based on serum and saliva respectively. The median (interquartile-range) 2-h stimulated salivary cortisol in Child A, B, C categories and controls were 1.36(1.23–2.38), 1.46(1.18–2.22), 1.72(1.2–2.2) and 2.12(1.42–2.72) μg/dL respectively. Six subjects (4.4%) were diagnosed to have AI based on stimulated salivary cortisol cut-off, whereas 39 (28.9%) cirrhosis subjects had inadequately stimulated serum cortisol. Three patients (symptomatic) required steroid replacement therapy. Hypoalbuminemia was identified as a major risk factor for the misdiagnosis of adrenal insufficiency by serum cortisol-based testing.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver. Stimulated salivary cortisol is a promising investigation for evaluation of adrenal function in cirrhosis and more studies are required for its further validation before clinical use.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen.15030","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Background

There are no reliable methods in clinical practice to diagnose adrenal insufficiency (AI) in patients with cirrhosis owing to variable cortisol-binding protein levels. This leads to unreliable results in ACTH stimulated serum cortisol test. We aimed to estimate the long-acting porcine (LA)ACTH-stimulated serum and salivary cortisol levels of patients at different stages of cirrhosis using second generation electrochemiluminescence and to determine the prevalence of true adrenal insufficiency in these patients.

Design, Patients and Measurements

We included 135 noncritical patients with cirrhosis (45 each from CHILD A, B and C) and 45 healthy controls. Serum and salivary samples were collected at baseline in the morning and at 1 and 2 h after LA-ACTH injection.

Results

In healthy subjects, the 2.5th centile of 2 h ACTH stimulated serum and salivary cortisol were 19.8 and 0.97 μg/dL, which were used as cut-offs for defining AI based on serum and saliva respectively. The median (interquartile-range) 2-h stimulated salivary cortisol in Child A, B, C categories and controls were 1.36(1.23–2.38), 1.46(1.18–2.22), 1.72(1.2–2.2) and 2.12(1.42–2.72) μg/dL respectively. Six subjects (4.4%) were diagnosed to have AI based on stimulated salivary cortisol cut-off, whereas 39 (28.9%) cirrhosis subjects had inadequately stimulated serum cortisol. Three patients (symptomatic) required steroid replacement therapy. Hypoalbuminemia was identified as a major risk factor for the misdiagnosis of adrenal insufficiency by serum cortisol-based testing.

Conclusions

Long-acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver. Stimulated salivary cortisol is a promising investigation for evaluation of adrenal function in cirrhosis and more studies are required for its further validation before clinical use.

查看原文本刊更多论文

与血清皮质醇相比，长效猪促肾上腺皮质激素刺激唾液皮质醇可减少肝硬化患者肾上腺功能不全的过度诊断。

背景：由于皮质醇结合蛋白水平的变化，临床实践中没有可靠的方法来诊断肝硬化患者的肾上腺功能不全（AI）。这导致促肾上腺皮质激素刺激血清皮质醇试验的结果不可靠。我们的目的是利用第二代电化学发光法估算不同阶段肝硬化患者的长效猪（LA）ACTH刺激血清和唾液皮质醇水平，并确定这些患者中真正肾上腺功能不全的患病率：我们纳入了 135 名非危重肝硬化患者（CHILD A、B 和 C 各 45 名）和 45 名健康对照者。在早上的基线以及注射 LA-ACTH 后 1 和 2 小时采集血清和唾液样本：在健康受试者中，2 h ACTH 刺激血清和唾液皮质醇的 2.5 百分位数分别为 19.8 和 0.97 μg/dL，这两个数值分别作为根据血清和唾液界定 AI 的临界值。儿童 A、B、C 组和对照组的 2 小时刺激唾液皮质醇中位数（四分位数间距）分别为 1.36（1.23-2.38）、1.46（1.18-2.22）、1.72（1.2-2.2）和 2.12（1.42-2.72）微克/分升。6名受试者（4.4%）根据刺激唾液皮质醇的临界值被诊断为 AI，而 39 名肝硬化受试者（28.9%）的血清皮质醇刺激不足。三名患者（无症状）需要类固醇替代治疗。低白蛋白血症是血清皮质醇检测误诊为肾上腺功能不全的主要风险因素：结论：与血清皮质醇相比，长效猪促肾上腺皮质激素刺激唾液皮质醇可减少肝硬化患者肾上腺功能不全的过度诊断。刺激唾液皮质醇是评估肝硬化患者肾上腺功能的一种很有前景的检查方法，在临床应用前还需要更多的研究来进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.