Abstract 91: ACTH stimulated salivary cortisol is a better indicator of adrenal insufficiency compared to stimulated serum cortisol in subjects with cirrhosis liver

Background: There are no reliable methods in clinical practice to diagnose adrenal insufficiency (AI) in patients with cirrhosis due to variably decreased cortisol binding protein levels. This leads to unreliable results on ACTH stimulated serum cortisol test. Aims and Objectives: To estimate the Long Acting (LA)-ACTH stimulated salivary cortisol levels of patients in different stages of cirrhosis using 2(nd) generation electrochemiluminescence and to find the prevalence of adrenal insufficiency in them. Results: LA-ACTH stimulated serum and saliva samples of 135 non-critically ill patients with cirrhosis (45 each from CHILD A, B and C) and 40 normal subjects were collected at baseline, 60 and 120-minutes. In healthy subjects, the 2.5(th) centile of 2 hr ACTH stimulated serum and salivary cortisol were 19.8 μg/dl and 0.97 μg/dl, which were used as cut-offs for defining AI based on serum and saliva respectively. The median (interquartile-range) 2-hour stimulated salivary cortisol in Child A,B,C categories and controls were 1.36 (1.23-2.38), 1.46 (1.18-2.22), 1.72 (1.2-2.2) and 2.12 (1.42-2.72) μg/dl respectively. 7 subjects (5.1%) were diagnosed to have AI based on stimulated salivary cortisol cut-off, whereas 39 (28.9%) cirrhosis subjects had inadequately stimulated serum cortisol. Three (symptomatic) subjects required steroid replacement. Conclusions: ACTH stimulated serum cortisol is a poor test to diagnose AI in patients with cirrhosis. ACTH stimulated salivary cortisol has a high reliability for the same.