Agustos 2012
Sirotik hastalarda adrenal yetmezlik prevalansi ve tanida tükürük kortizolünün yeri
The prevalence of adrenal insufficiency in cirrhosis and the role of salivary cortisol in the diagnosis
- Ana Sayfa
- Sayılar
- Agustos 2012
- Sirotik hastalarda adrenal yetmezlik prevalansi ve tanida tükürük kortizolünün yeri...
Özet
Giris ve Amaç: Stabil sirotik hastalarda, total kortizol ve tükürük kortizolüne göre adrenal yetmezlik prevalansinin belirlenmesi ve tanida bu kriterlerin uyumunun arastirilmasi amaçlanmistir. Gereç ve Yöntem: Çalismaya 110 hasta ve 30 saglikli kontrol alindi. Hasta ve kontrollerin bazal tam kan sayimi, albümin, bilirubin, protrombin zamani, total kortizol, tükürük kortizolü, kortizol baglayaci globülin degerleri ölçüldü. Serbest kortizolleri Coolens formülü ile hesaplandi. Hastalarin 250 mg synacten uygulanmasi sonrasi, 1. saatte total ve tükürük kortizolü ölçülüp, serbest kortizol düzeyleri hesaplandi. Bulgular: Hastalari n yas ortalamasi 62.1±11.4 yil olup, 54?ü (%49.1) erkek idi. Ortalama Child skoru 7.2±2.3 olup, 56?si (%50.9) Child A, 32?si (%29.1) Child B ve 22?si (%20) Child C idi. Total kortizole göre 23 (%20.9), serbest kortizole göre ise 17 hastada (%15.5) adrenal yetmezlik saptandi. Yirmidört hasta (%21.8) tükürük kortizolü için tani kriterlerinden en az birini sagladi. Bazal tükürük kortizolü <1.81 ng/ml olup, ACTH sonrasi yeterli tükürük kortizol artisi saglayamayanlar ile tükürük kortizolü 1.saat <4.96 ng/ml ve delta <3 ng/ml olanlar gerçek adrenal yetmezlik için daha yüksek olasilikli olup, hastalarin %12.7?sini olusturmustur. Tükürük ve total kortizol kriterlerinin uyumu zayif saptandi (kappa: 0.161). Bazal total kortizol, bazal tükürük kortizolü (r:0.502, p<0.0001) ve serbest kortizol ile (r:0.579, p<0.0001) orta derecede pozitif korelasyon gösterdi. Bazal tükrük kortizolü ve serbest kortizol arasi nda ise güçlü korelasyonu saptandi (r: 0.706, p<0.0001). Sonuç: Siroz hastalarinda, total kortizole göre adrenal yetmezlik, serbest ve tükürük kortizolüne kiyasla daha yüksek saptanmistir. Tükürük kortizolü serbest kortizol ile güçlü korelasyon göstermesi nedeniyle, sirotik hastalarda adrenal yetmezlik tanisi için uygun bir seçenek olabilir.
Abstract
Background and Aims: The objective of this study was to assess the prevalence of adrenal insufficiency according to total and salivary cortisol and to evaluate the discrepancy between these parameters for diagnosis among stable cirrhotic patients. Materials and Methods: A total of 110 consecutive patients with cirrhosis and 30 healthy controls were enrolled into the study. Baseline complete blood count, albumin, bilirubin, prothrombin time, and total and salivary cortisol levels were measured in both patients and controls and free cortisol level was calculated according to Coolens formula. One hour after the administration of 250 μg synacthen, total and salivary cortisol levels were measured and free cortisol was calculated accordingly. Results: The mean age of the patients was 62.7±11.4 years, and there were 54 males (49.1%). Adrenal insufficiency was present in 23 (20.9%) and 17 (15.5%) patients according to total and free cortisol, respectively. At least one of the criteria for adrenal insufficiency for salivary cortisol was present in 24 (21.8%) patients. Patients with baseline salivary cortisol <1.81 ng/ml and without satisfactory cortisol increase following ACTH test, and all patients with salivary cortisol level measured as <4.96 at 1 hour with delta of <3 ng/ml, regardless of baseline value, were accepted as having adrenal insufficiency with the highest probability; these constituted 12.7% of all patients. Baseline total cortisol showed a low correlation with salivary and free cortisol (r: 0.502 and r: 0.579, respectively). In contrast, the correlation between salivary and free cortisol was relatively higher (r: 0.706, p<0.0001). Conclusions: Adrenal insufficiency was diagnosed more commonly according to total cortisol when compared to salivary and free cortisol. Regarding the higher correlation of free cortisol with salivary cortisol relative to total cortisol, salivary cortisol could be a suitable alternative for the diagnosis of adrenal insufficiency in patients with cirrhosis.
