الفهرس 
Chronic Liver DiseaseOnly 14 pages are availabe for public view
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Abstract
The present study was designed to assess fasting morning plasma cortisol & ACTH in children with chronic liver disease and to relate fasting morning plasma cortisol &ACTH to severity of liver disease. This study included 40 children with chronic liver diseases who were recruited from the pediatric hepatology clinic, children’s hospital, Ain Shams University and 30 age and sex matched controls who were recruited from pediatric outpatient clinic of the same hospital. All children were subjected to the following: full medical history; thorough clinical examination, measurement of weight, height, calculation of height for age standard deviation score (SDS) and weight for height standard deviation score; severity of liver disease was assessed using Child- Pugh classification and finally fasting morning cortisol and ACTH were determined.
The results of the present study revealed the following:
• The present study included 40 cases with chronic liver disease; 47.5% were males and 52.5% were females
• 45% of cases were grade A, 30% were grade B and 25% were grade C.
• Liver enlargement was reported in 36 cases (90.0%); spleen enlargement in 28 cases (70.0%); jaundice in 14 cases (35.0%); past history of convulsion in 8 cases (20.0%); changed mental state in 2 cases (5.0%); itching in 2 cases (5.0%); while none of the patients had lower limb edema.
• Plasma cortisol ranged from 3-22(µg/dL) with a mean of 15.27±2.64 (µg/dL) while morning plasma ACTH ranged from 21 to 129 (pg/dL) with a mean of 83.27±22.03 (pg/dL).
• Increased ACTH only (compensated) were 13 (32.5%), while cases with increased ACTH plus decreased cortisol (decompensated) were 3 (7.5%).
• All anthropometric parameters were significantly lower among cases than controls
• ALT, AST and total bilirubin were significantly higher among cases than controls.
• Fasting morning plasma cortisol was significantly lower and ACTH significantly higher among cases when compared to controls.
• In the present study, there was significant differences between child’s A,B and C as regards weight for age SDS,BMI,BMI SDS.
• In the present work, there were non-significant differences between different grades as regards ALT and AST, while there were significant differences between different grades as regards bilirubin, serum bilirubin and INR.
• As regard hormonal profile, there was significant decrease of plasma cortisol with increasing child grade and significant increase in plasma ACTH with increasing grade.
• In the present study, there was significant, positive correlation between fasting cortisol from one side and each of height SDS, weight SDS; while there was significant, inverse correlation between fasting cortisol from one side and ALT, AST, INR and severity from other side.
• There was significant positive, correlations between ACTH and each of bilirubin and severity.