Prevalence of adrenal dysfunction in patients with liver cirrhosis

Background and aim: Adrenal insufficiency represents an essential topic with great variation in its prevalence in the spectrum of chronic liver diseases. So we assessed the prevalence of adrenal insufficiency (AI) & relative adrenal insufficiency (RAI) in patients with liver cirrhosis. Patients and methods: In a cross-sectional hospital- based observational study, 80 patients previously diagnosed as hepatitis C and or B-induced liver cirrhosis were recruited from the inpatient unit of the internal medicine department, AL Kasr Al Aini Hospital, Cairo University. Patients were subdivided into 3 groups, (A): patients with compensated liver cirrhosis, (B): patients with decompensated liver cirrhosis without infections and group (C): patients with decompensated liver cirrhosis with infections. Hormonal assessment of adrenal function including adrenocorticotropin (ACTH) stimulation test and serum total cortisol was estimated by ELISA. Results: The average serum basal total cortisol level, cortisol after stimulation and delta cortisol was significantly low in group(C) with mean (8.56±1.40, 17.52±2.94, 9.38±2.91) respectively as compared with other groups, P value <0.001. The cortisol level after ACTH was inversely correlated with child -Turcotte-Pugh and model of the end-stage liver disease (MELD) score in decompensated liver cirrhosis. Conclusion: (AI) presented in (80%) of patients with decompensated liver cirrhosis with infections and (RAI) presented in (56.7%) of patients with decompensated liver cirrhosis without infections. Ascites, spontaneous bacterial peritonitis, high Child and MELD score, low levels HDL and LDL cholesterol were predictors of AI and require regular evaluation of adrenal function.