Publication:

Relative adrenal insufficiency in non-critically ill liver cirrhosis

Background Endocrinopathy like adrenal insufficiency (AI) is being increasingly recognised in patients with liver cirrhosis. It is characterized by a relative decrease in serum cortisol level with respect to increasing stress as occurs in sepsis & has been associated with increased morbidity and mortality. This study aimed to find the prevalence of Adrenal insufficiency and low HDL in non-critically ill chronic liver disease (CLD) patients i.e. patients without sepsis, bleed or dehydration.

Methodology A cross-sectional study including 100 non-critically ill CLD patients aged 20 -80 years. Model for end stage liver disease (MELD) scores and the Child Turcotte Pugh scores (CTP) were used to assess the severity of liver disease. Basal cortisol level was measured & after one hour of short synacthen test (SST), peak and delta cortisol levels were measured in order to assess adrenal function. Biochemical parameters including HDL levels were also assayed.

Results This study included 76 male and 24 female CLD patients. Prevalence of AI was highest in females of age 41-60 years. Alcohol (61%) was the most common etiology, followed by MASLD and HBV. Prevalence of AI was 55.6%, 60.5% and 65.9% in CTP class A, B and C respectively. Prevalence of AI in the high MELD (>15) group was 66.7% and 50% in the low MELD (<14) group. Low HDL and AI were reported in CTP classes B and C.

Conclusion Adrenal insufficiency is common in patients with non-critically ill chronic liver disease; which increases with severity of disease; and whose HDL levels are low.