Patient selection: acute alcoholic hepatitis
Patient exclusion: cirrhosis (associated with hepatoadrenal syndrome); high baseline serum cortisol (> 33 micrograms per dL)
Features:
(1) severe alcoholic hepatitis with systemic inflammation
(2) relative glucocorticoid deficiency
Hypotheses for relative glucocorticoid deficiency:
(1) reduced secretion (supported by suppressed response to ACTH)
(2) increased demand
(3) resistance to activity
(4) mixed
Criteria for adrenal insufficiency: < 7/dL microgram increase in serum cortisol level from baseline 1 hour after IM injection of 25 IU ACTH.
One manifestation may be a clinical response to exogeneous corticosteroid therapy.
Looking at Figure 2:
(1) A Maddrey discriminant function (DF) <= 32 is associated with a normal response to ACTH.
(2) The response to ACTH can be normal or abnormal with a DF from 33 to 140.
(3) A DF above 140 is associated with an abnormal ACTH response.
