Filiz ARAZ, Birol ÖZER, Barış SOYDAŞ, Ender SERİN

Sirotik hastalarda adrenal yetmezlik prevalansı ve tanıda tükürük kortizolünün yeri

Giriş ve Amaç: Stabil sirotik hastalarda, total kortizol ve tükürük kortizolüne göre adrenal yetmezlik prevalansının belirlenmesi ve tanıda bu kriterlerin uyumunun araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 110 hasta ve 30 sağlıklı kontrol alındı. Hasta ve kontrollerin bazal tam kan sayımı, albümin, bilirubin, protrombin zamanı, total kortizol, tükürük kortizolü, kortizol bağlayacı globülin değerleri ölçüldü. Serbest kortizolleri Coolens formülü ile hesaplandı. Hastaların 250 mg synacten uygulanması sonrası, 1. saatte total ve tükürük kortizolü ölçülüp, serbest kortizol düzeyleri hesaplandı. Bulgular: Hastaların yaş ortalaması 62.1±11.4 yıl olup, 54’ü (%49.1) erkek idi. Ortalama Child skoru 7.2±2.3 olup, 56’sı (%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 saptandı. Yirmidört hasta (%21.8) tükürük kortizolü için tanı kriterlerinden en az birini sağladı. Bazal tükürük kortizolü < 1.81 ng/ml olup, ACTH sonrası yeterli tükürük kortizol artışı sağlayamayanlar ile tükürük kortizolü 1.saat < 4.96 ng/ml ve delta < 3 ng/ml olanlar gerçek adrenal yetmezlik için daha yüksek olasılıklı olup, hastaların %12.7’sini oluşturmuştur. Tükürük ve total kortizol kriterlerinin uyumu zayıf saptandı (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 arasında ise güçlü korelasyonu saptandı (r: 0.706, p < 0.0001). Sonuç: Siroz hastalarında, total kortizole göre adrenal yetmezlik, serbest ve tükürük kortizolüne kıyasla daha yüksek saptanmıştır. Tükürük kortizolü serbest kortizol ile güçlü korelasyon göstermesi nedeniyle, sirotik hastalarda adrenal yetmezlik tanısı için uygun bir seçenek olabilir.

Anahtar Kelimeler:

Siroz, adrenal yetmezlik, tükürük kortizolü

The prevalence of adrenal insufficiency in cirrhosis and the role of salivary cortisol in the diagnosis

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

Keywords:

Cirrhosis, adrenal insufficiency, salivary cortisol,

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