Update on adrenal insufficiency in patients with liver cirrhosis

Table 2 Prevalence of adrenal insufficiency in patients with liver cirrhosis, not critically ill

Ref.	No. of patients (type of cirrhosis)	Diagnosis and definition of AI	Prevalence of AI
McDonald et al[69]	38 (stable cirrhosis)	IIHT: Reduction in maximal increments of plasma cortisolSD-SST: Reduction in maximal increments of plasma cortisol	64%39%
Zietz et al[112]	52 (stable cirrhosis)	CRHT: Peak cortisol < 550 nmol/L or an increase < 250 nmol/L1rise of plasma ACTH < twice the baseline	58%42%
Sigalas et al[87]	47 (stable cirrhosis)	SD-SST: Baseline cortisol < 250 nmol/L and delta cortisol < 250 nmol/L	36%
Alessandria et al[88]	25 (cirrhosis and ascites)	SD-SST: Delta cortisol < 250 nmol/L	36%
Jang et al[63]	18 (stable cirrhosis)	SD-SST: Baseline cortisol < 414 nmol/L delta cortisol < 250 nmol/L	83%
Acevedo et al[19]	198 (10 compensated and 188 decompensated cirrhosis)	SD-SST: Baseline cortisol < 414 nmol/Ldelta cortisol < 250 nmol/L	64%27%
Galbois et al[45]	88 (stable cirrhosis)	SD-SST: (1) Serum total cortisol: Baseline cortisol < 250 nmol/L or peak cortisol < 500 nmol/L or delta cortisol < 250 nmol/L(2) Salivary cortisol: Basal salivary cortisol < 1.8 ng/mL or post-stimulation values < 12.7 ng/mL or increase values < 3 ng/mL	33% 9%
Tan et al[15]	43 (stable cirrhosis)	SD-SST: Peak total cortisol < 500 nmol/L; delta cortisol < 250 nmol/L; peak plasma free cortisol < 33 nmol/L; any set of criteria	39%47%12%58%
Thevenot et al[67]	95 (stable cirrhosis)	LD-SST: Baseline cortisol < 138 nmol/L; < 440 nmol/L after stimulation; ≤ 500 nmol/L after stimulation; delta cortisol < 250 nmol/L	7%19%27%49%
Fede et al[17]	101 (stable cirrhosis)	LD-SST: Peak serum cortisol < 500 nmol/L; peak serum cortisol < 442 nmol/L; delta cortisol < 250 nmol/L	38%29%60%
Triantos et al[16]	60 (stable cirrhosis)	SD-SST: Peak serum cortisol < 500 nmol/LLD-SST: Peak serum cortisol < 500 nmol/L	30%48%
Mohamed et al[85]	15 (stable cirrhosis)	SD-SST: Definition of AI was not reported	53%
Risso et al[18]	85 (cirrhosis with ascites, without sepsis or shock)	SD-SST: Delta cortisol < 250 nmol/L and/or peak cortisol < 500 nmol/L	39%
Vincent et al[73]	26 (liver impairment)	SD-SST: Serum total cortisol < 550 nmol/L; free cortisol index < 12	46%13%

¹To convert serum total cortisol concentrations from nanomoles per liter to micrograms per deciliter divide by 27.59[79]. AI: Adrenal insufficiency; SD-SST: Standard dose short synacthen test; LD–SST: Low dose short synacthen test; CRHT: Corticotropin-releasing hormone test; IIHT: Insulin-induced hypoglycemia test; ACTH: Adrenocorticotropic hormone.