Aldosterone-renin system (ARS), cortisol secretion and adrenal androgen function in cirrhosis

ALDOSTERONE-RENINSYSTEM (ARS), CORTISOL SECRETIONAND ADRENAL ANDROGENFUNCTION IN CIRRHOSIS. F. Corso, F . Capra, S. Ferrari °, M. Casaril, F. Aprili °, L. Rossi°, G.B. Gabrielli and R. Corrocher; Institute of Medical Pathology and o Institute of Clinical Chemistry - University of Verona, Italy. ARS,cortisol rhythm, dehydroepiandrosterone sulphate (DEHA-S) and urinary excretion of 22 steroid derivatives have been studied in 35 cirrhotics (18 males/17 females) and compared with values of 35 controls, matched for sex and age. ARS was normal or slightly stimulated in cirrhosis. Cortiso] secretion was normal in cirrhotics, with a slight alteration of circadian rhythm in 35% of patients. The major finding noted concerned the secretion of DEHA-S: in cirrhosis i t was extremely reduced both in males (548~518 ng/ml vs 1248~413 ng/ml; p < 0.001) and in females (236~191 ng/ml vs 1049~402 ng/ml; p < 0.001). Cirrhotics females had lower mean value of DEHA-S than males (p < 0.02). Moreover, decompensated tended to have lo wer values than compensated patients. The gas chromatographic profile of adrenal steroid excretion was characterized by a remarkable reduction of all the 22 compounds studied. However, the gonado-adrenal and pregnan-derivatives were the most affected compounds. The data presented here show a remarkable impairment of synthesis and secretion of adrenal androgen compounds in cirrhosis, whereas ARS and cortisol secretion remain normal, or slightly s t i mulated.

PROGNOSTIC FACTORS IN LIVER CIRRHOSIS A.Cristani,G.Cioni,D.Anderlini,P.Baldoni,L.Di Pancrazio,S.Grandi,G.Minetto, S.Petrella,M.L.Ze~eroli,E.Ventura Clinica Medica III-Universit& di Modena,Italy.

Numerous data have been considered as prognostic index in liver cirrhosis patients (LCP) with some diverging results.With the aim of identifying these factors in our LCP a clinical study on 293 consecutive LCP hospitalized for the first time in 1981 and subsequently observed until December 1985 has been carried out. Statistical Package for Social Science including 192 variables in each patient was used.The graph of survival function has been evaluated by the method of Peto et al. and compared by Log-Rank test. Mean age of LCP was 51.8±11.3 y (62.5 % males);35% were post-necrotic (PN),25.6% alcooholic (A),34.8% cryptogenetic (C).Overall median survival time was 88 months.The Child's classification and 12 separate variables were evaluated for their prognostic value and results are reported in the Table. VARIABLE GROUPS P VARIABLE GROUPS P Age (years) < 50 /> 50 0.0079 Thrombocitopenia no / yes n.s. Sex male / female n.s. HBsAg - / + n.s. EthioloKy PN / A / C n.s. Ascitis absent/mild/severe 0.0001 Albumin(g/dl) >3.5/3.4-3/<2.9 0.0001 Encephalopathy no / yes 0.0133 Bilirubin(mg/dl) ~2.9/3-3.9/>4 0.0002 Esophageal varices no / yes 0.0065 Prothrombin(%) >70 / < 70 0.0006 Child's groups A / B / C 0.0001 Cholinesterase >3 / 3-2 /< 2 0.0001 Unlike previous studies of all studied variables sex,thrombocitopenia ,ethiology and HBsAg positivity had no significant

prognostic value.

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