Euroasian Journal of Hepato-Gastroenterology

Register      Login

VOLUME 2 , ISSUE 2 ( July-December, 2012 ) > List of Articles

ORIGINAL ARTICLE

Features of Hormonal Disturbances in Cirrhotic Patients with Hepatic Encephalopathy

Tarek A Besheer, Mona Arafa, Ghada Elkannishy, Mona A El-hussiny, Ehab B Rakha

Citation Information : A Besheer T, Arafa M, Elkannishy G, A El-hussiny M, B Rakha E. Features of Hormonal Disturbances in Cirrhotic Patients with Hepatic Encephalopathy. Euroasian J Hepatogastroenterol 2012; 2 (2):84-89.

DOI: 10.5005/jp-journals-10018-1040

License: CC BY-NC 4.0

Published Online: 01-07-2012


Abstract

Background: Features of hormone disturbances in patients suffering from chronic hepatic failure have been documented for many years. Objective: To evaluate the possible diagnostic and prognostic values of cortisol, total T3, thyroid-stimulating hormone (TSH) and prolactin concentrations in cirrhotic patients for prediction of hepatic encephalopathy (HE) and severity of hepatic diseases. Materials and methods: Study was carried out on 75 (40 males, 35 females) cirrhotic patients (HCV positive) with HE and 50 (28 males, 22 females) cirrhotic patients without HE (HCV positive). Patients underwent clinical evaluation with determination of the degree of HE. The severity of cirrhosis was assessed according to Child-Pugh classification. Immulite 1000 chemiluminescent immunometric assay was used for determination of cortisol, total T3, TSH and prolactin. Results: Cortisol, total T3 concentrations were significantly decreased in cirrhotic patients with HE compared to those without HE. Cutoff value for cortisol was less than 18.3 mg/dl could predict HE in cirrhotic patients according to AUROC curve showing a sensitivity of 52% and a specificity of 61%. Cutoff value for total T3 of less than 45.5 ng/dl could predict HE in cirrhotic patients showing a sensitivity of 64% and a specificity of 80.6%. Whereas prolactin concentration in cirrhotic patients with HE was significantly increased compared to patients without HE and its cutoff value was more than 18.85 ng/dl could predict HE in cirrhotic patients showing a sensitivity of 88% and a specificity of 90.3%. TSH concentration showed no significant difference in patients with HE vs patients without HE. Conclusion: Hormonal abnormalities of cortisol, total T3 and prolactin may represent risk factors and early indicators of impending hepatic encephalopathy and progression of liver disease severity.


PDF Share
  1. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34:768-73
  2. Sex hormone changes associated with liver disease. Endocrinology 1940;27:749-52
  3. Hypothalamic-pituitary-gonadal function in men with cirrhosis of the liver. GUT 1976;17:345-50
  4. Prognostic value of thyroid hormon levels in patients evaluated for liver transplantation. Hepatology 1985;5:862-66
  5. Growth hormone, insulin-like growth factor binding proteins 1 and 3 in chronic liver disease. Hepatology 1995;21:680-88
  6. Metabolism of adrenal cortical steroid. In: Christy NP (Ed). The Human Adrenal Cortex. New York: Harper & Row 1971:81-189
  7. Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival. Hepatology 2006;44:1288-95
  8. Associations between diseases of the thyroid and the liver. Am J Gastroenterol 1984;79:421-23
  9. Low serum total thyroxine and free triiodothyronine in patients with hepatic encephalopathy due to non-alcoholic cirrhosis. Swiss Med Wkly 2003;133: 210-13
  10. The relationship between the thyroid gland and the liver. QJ Med 2002;95:559-69
  11. Alcohol, liver cirrhosis and disorders in sex hormone metabolism. Acta Clin Belg 1993;48:269-83
  12. Dysfunction of the hypothalamicpituitary- glandular axes and relation to Child-Pugh classification in male patients with alcoholic and virus-related cirrhosis. Eur J Gastroenterol Hepatol 2003;15: 495-501
  13. Male gonadal function, prolactin secretion and lactotroph population in an experimental model of cirrhosis, endocrine function and cirrhosis of the liver. Braz J Med Biol Res 2007;40: 1383-88
  14. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-49
  15. Hepatic encephalopathy definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998. Hepatology 2002;35:716-21. Features of Hormonal Disturbances in Cirrhotic Patients with Hepatic Encephalopathy Euroasian Journal of Hepato-Gastroenterology, July-December 2012;2(2):84-89 89 EJOHG 16. Foster L, Dunn R. Single-antibody technique for radioimmunoassay of cortisol in unextracted serum or plasma. Clin Chem 1974;20:365
  16. Serum triiodothyronine in man. Annu Rev Med 1974;25:289-302
  17. Thyrotropin releasing hormone-TSH. Clin Endocrinol Metab 1977;6:83-100
  18. Metoclopramide: An updated review. Drugs 1983;25:451-94
  19. World J Gastroenterol 2010;16:3347-57
  20. Bacterial translocation in cirrhosis. Hepatology 2005;41:422-33
  21. Bacterial infection in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002;35:140-48
  22. Cirrhosis as a risk factor for sepsis and death: Analysis of the National Hospital Discharge Survey. Chest 2003;124:1016-20
  23. Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology 2006;43:673-81
  24. The clinical importance of adrenal insufficiency in acute hepatic dysfunction. Hepatology 2002;36:395-402
  25. Adrenal-exhaustion syndrome in patients with liver disease. Intensive Care Med 2006;134:275-80
  26. Tumour necrosis factor a is an important mediator of portal and systemic haemodynamic derangements in alcoholic hepatitis. GUT 2003;52:1182-87
  27. Fast resolution of hypercortisolism in dogs with portosystemic encephalopathy after surgical shunt closure. Res Vet Sci 1999;66:63-67
  28. Relationship of altered thyroid hormone indices to survival in nonthyroidal illnesses. Clin Endocrinol 1982;16:565-74
  29. Thyroid hormones and thyroxinebinding globulin in relation to liver function and serum testosterone in men with alcoholic cirrhosis. Acta Med Scand 1988;224:367-73
  30. Reduced peripheral conversion of thyroxine to triiodothyronine in patients with hepatic cirrhosis. J Clin Invest 1975;56:643-52
  31. Pituitary and thyroid hormone levels before and after orthotopic hepatic transplantation and their response to thyrotropin-releasing hormone. J Clin Endocrinol Metab 1985;60:569-74
  32. Serum thyroid hormone levels in patients with liver disease. Arch Intern Med 1979;139:1117-20
  33. Observation on serum prolactin in hepatic cirrhosis. J Indian Med Assoc 1991;89:307-08
  34. Impact of basal prolactin levels on the prevalence of complications and the prognosis of patients with liver cirrhosis. Vnitr Lek 2009;55:468-73.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.