Features of Hormonal Disturbances in Cirrhotic Patients with Hepatic Encephalopathy

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.