Evidence map›Paper›PMID 34876016›Full record

ArticleBMC gastroenterology2021

Hypercortisolism in patients with cholestasis is associated with disease severity.

Verena Theiler-Schwetz, Hansjörg Schlager, Barbara Obermayer-Pietsch, Tatjana Stojakovic, Günter Fauler, Peter Fickert, Gernot Zollner

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.4field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 4 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Verena Theiler-SchwetzDivision of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, University Hospital Graz, Graz, Austria.
Hansjörg SchlagerDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, University Hospital Graz, Graz, Austria.
Barbara Obermayer-PietschDivision of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, University Hospital Graz, Graz, Austria.
Tatjana StojakovicClinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Graz, Austria.
Günter FaulerClinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Graz, Austria.
Peter FickertDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, University Hospital Graz, Graz, Austria.
Gernot ZollnerDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, University Hospital Graz, Graz, Austria. Gernot.zollner@medunigraz.at.
Medical University of Graz · ATGraz University Hospital · AT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCholestasis might lead to an impairment of adrenal function as suggested by in vitro and in vivo data as well as by clinical findings. Bile acid and adrenal steroid metabolism not only share the receptors farnesoid X receptor (FXR) and the G protein-coupled bile acid receptor 1 (TGR5), but supraphysiological bile acid levels were found to stimulate steroidogenesis independent of FXR and TGR5. Our previous experimental findings revealed that mice fed bile acids or subjected to common bile duct ligation develop hypercortisolemia. We thus aimed to assess adrenal gland function in patients with cholestasis.

methodsAdrenal gland function was assessed in 36 patients with cholestasis and in 32 patients without cholestasis by measuring total serum cortisol, adrenocorticotropic hormone (ACTH), as well as the increase of cortisol 20 and 30 min after administration of 1 µg of ACTH. Bile acid levels and bile acid pool composition were determined by high-resolution mass spectrometry.

resultsPatients with cholestasis per definition had markedly elevated levels of alkaline phosphatase (AP), bilirubin and serum bile acids. Baseline cortisol and maximum cortisol after ACTH stimulation were significantly higher in patients with cholestasis compared to controls. Increase of cortisol after ACTH stimulation and ACTH did not differ. In the cholestasis group, baseline cortisol correlated with bilirubin but not with AP, total serum bile acids and levels of conjugated and unconjugated bile acid species. Patients with duration of cholestasis < 6 months (n = 30) had significantly higher baseline cortisol levels than those with long standing cholestasis (> 6 months), together with higher bilirubin levels.

conclusionsWe find no evidence of adrenal insufficiency in non-cirrhotic patients with cholestasis. In contrast, patients with cholestasis show hypercortisolism associated with disease severity as mirrored by levels of bilirubin. Lack of ACTH increase in cholestasis suggests a direct effect of cholestasis on adrenals and not on the pituitary gland. Further studies are needed to elucidate the mechanism of cortisol elevation in patients with cholestasis and its clinical significance.

Indexed as

CholestasisCushing SyndromeAnimalsHumansHydrocortisoneHypothalamo-Hypophyseal SystemMicePituitary-Adrenal SystemSeverity of Illness IndexHydrocortisoneAdrenal glandBile acidsBilirubinCholestasisCortisolHypothalamic–pituitary–adrenal axis (HPA axis)

Identifiers

PMID34876016
PMCPMC8650422
OpenAlexW4200015126

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.