Long‐acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver
Authors' conclusion
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.
Study context
- Population
- Noncritical patients with cirrhosis at different stages and healthy controls; serum and salivary samples at baseline and 1 and 2 h after LA-ACTH injection135 cirrhosis, 45 controls
- Participants
- 45 / 45 / 45 / 45
- Exposure
- LA-ACTH-stimulated salivary vs serum cortisol for diagnosing adrenal insufficiency (AI) in cirrhosis
- Child An = 45
- Child Bn = 45
- Child Cn = 45
- Controlsn = 45reference
- Outcome
- Prevalence of true AI by LA-ACTH-stimulated serum and salivary cortisol
- Follow-up
- 2 h after LA-ACTH
Main finding
As reported in the abstract
AI diagnosis in cirrhosis (cut-offs: 2.5th centile in controls, serum 19.8 and saliva 0.97 μg/dL) · 2 h
AI by stimulated salivary cortisol cut-off
6
4.4%
Inadequately stimulated serum cortisol
39
28.9%
Observational data: associations, not effects.
Further findings
2-h stimulated salivary cortisol
Steroid replacement therapy required
- Symptomatic patients requiring steroid replacement
- 3
Risk factor for misdiagnosis of AI by serum cortisol testing
- Hypoalbuminemia identified as a major risk factor
Original publication
Long‐acting porcine ACTH stimulated salivary cortisol reduces the overdiagnosis of adrenal insufficiency compared to serum cortisol in cirrhosis liver. Clin Endocrinol (Oxf). Published 18 February 2024. doi:10.
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