Relative Adrenal Insufficiency in Patients With Chronic Liver Disease

Abstract

In Brief The objective of this overview is to examine the prevalence, pathophysiology, diagnosis, and treatment of relative adrenal insufficiency (RAI) in patients with chronic liver disease. Several studies have demonstrated a high prevalence of RAI in this population, especially with advanced liver disease and during critical illness. The mechanisms of RAI include dysfunction of the hypothalamic-pituitary-adrenal axis, changes in circulating hormones, and peripheral glucocorticoid resistance. These are due, at least in part, to the increased levels of proinflammatory cytokines and lipopolysaccharides observed in this population. There is continued controversy about the best diagnostic test for RAI, because of the limitations of the current case definitions. Only a few studies examined the effect of hydrocortisone therapy in patients with liver disease and showed improvement in hemodynamic abnormalities. However, the effect on survival was not consistent in these studies. Further research in this area is needed to identify the best diagnostic and therapeutic approach to this important entity. Relative adrenal insufficiency has increasingly been recognized in patients with chronic liver disease especially those who are critically ill, opening new potential therapeutic frontiers. The objective of this review is to examine the prevalence, pathophysiology, diagnosis, and treatment of this important entity.