Title: Hypercortisolism in Patients with Cholestasis is Associated with Disease Severity
Version: 2 Date: 07 Apr 2021
Reviewer's report:
It is suggested that studies of this background in patients with chronic cholestasis may yield
valuable results.
1. Adrenal insufficiency is found in patients with liver cirrhosis. This condition terms “hepato-
adrenal syndrome”. I wonder the possible pathogenesis which helping to establish association
between hypercortisolism and cholestasis.
2. The sample size is small. The author did not detail how the patients were recruited.
3. The author should explain the reasons why 1 ug ACTH was given in cholestatic patients with
hypercortisolism.
4. Several causes, including DILI, PSC, cancer, and autoimmune pancreatitis, was identified
in cholestatic patients. I wonder whether these causes had some effects on glucocorticoid
metabolism. In addition, cholestatic patients without definite causes were excluded from this
study?
5. The author also should detail the clinical diagnosis of patients without cholestasis, who served
as control in this study.
6. The results show that patients with chronic cholestasis have higher TB levels than patients
with acute cholestasis. This might be not true because of the small sample. I prefer the author
compared the baseline cortisol and ATCH levels between with severe cholestasis and mild
cholestasis.
7. The authors state that “Baseline cortisol was significantly higher in the carcinoma group”.
This indicates the influence of cancer on cortisol levels. It is greater to enroll cholestatic patients
with causes influencing cortisol levels, such cholestatic infants.
Title: Hypercortisolism in Patients with Cholestasis is Associated with Disease Severity
Version: 2 Date: 07 Apr 2021
Reviewer's report:
It is suggested that studies of this background in patients with chronic cholestasis may yield
valuable results.
1. Adrenal insufficiency is found in patients with liver cirrhosis. This condition terms “hepato-
adrenal syndrome”. I wonder the possible pathogenesis which helping to establish association
between hypercortisolism and cholestasis.
2. The sample size is small. The author did not detail how the patients were recruited.
3. The author should explain the reasons why 1 ug ACTH was given in cholestatic patients with
hypercortisolism.
4. Several causes, including DILI, PSC, cancer, and autoimmune pancreatitis, was identified
in cholestatic patients. I wonder whether these causes had some effects on glucocorticoid
metabolism. In addition, cholestatic patients without definite causes were excluded from this
study?
5. The author also should detail the clinical diagnosis of patients without cholestasis, who served
as control in this study.
6. The results show that patients with chronic cholestasis have higher TB levels than patients
with acute cholestasis. This might be not true because of the small sample. I prefer the author
compared the baseline cortisol and ATCH levels between with severe cholestasis and mild
cholestasis.
7. The authors state that “Baseline cortisol was significantly higher in the carcinoma group”.
This indicates the influence of cancer on cortisol levels. It is greater to enroll cholestatic patients
with causes influencing cortisol levels, such cholestatic infants.
Please review this paper.
user
Title: Hypercortisolism in Patients with Cholestasis is Associated with Disease Severity
Version: 2 Date: 07 Apr 2021
Reviewer's report:
It is suggested that studies of this background in patients with chronic cholestasis may yield
valuable results.
1. Adrenal insufficiency is found in patients with liver cirrhosis. This condition terms “hepato-
adrenal syndrome”. I wonder the possible pathogenesis which helping to establish association
between hypercortisolism and cholestasis.
2. The sample size is small. The author did not detail how the patients were recruited.
3. The author should explain the reasons why 1 ug ACTH was given in cholestatic patients with
hypercortisolism.
4. Several causes, including DILI, PSC, cancer, and autoimmune pancreatitis, was identified
in cholestatic patients. I wonder whether these causes had some effects on glucocorticoid
metabolism. In addition, cholestatic patients without definite causes were excluded from this
study?
5. The author also should detail the clinical diagnosis of patients without cholestasis, who served
as control in this study.
6. The results show that patients with chronic cholestasis have higher TB levels than patients
with acute cholestasis. This might be not true because of the small sample. I prefer the author
compared the baseline cortisol and ATCH levels between with severe cholestasis and mild
cholestasis.
7. The authors state that “Baseline cortisol was significantly higher in the carcinoma group”.
This indicates the influence of cancer on cortisol levels. It is greater to enroll cholestatic patients
with causes influencing cortisol levels, such cholestatic infants.
assistant