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Relative adrenal insufficiency is a prognostic factor in chronic liver disease

A study published ahead of print in the Alimentary Pharmacology & Therapeutics evaluates the prevalence of relative adrenal insufficiency in chronic liver disease, and its effects on long-term mortality.

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The relationship between relative adrenal insufficiency and chronic liver disease is unclear.

Dr Sohn and colleagues from Korea determined the frequency with which relative adrenal insufficiency is observed in noncritically ill patients at various stages of chronic liver.

The team also assessed the correlation between relative adrenal insufficiency and disease severity and long-term mortality.

In total, 71 non-critically ill patients with liver cirrhosis and chronic hepatitis were evaluated prospectively.

A short stimulation test (SST) with 250 µg of corticotrophin was performed to detect relative adrenal insufficiency.

Relative adrenal insufficiency was observed in 24% of patients with cirrhosis
Alimentary Pharmacology & Therapeutics

Relative adrenal insufficiency was defined as an increase in serum cortisol of <9 µg/dL in patients with a basal total cortisol of <35 µg/dL.

The team observed relative adrenal insufficiency in only 24% of patients with cirrhosis.

Compared to those without relative adrenal insufficiency, the researchers found that cirrhotic patients with relative adrenal insufficiency had significantly higher Child-Turcotte-Pugh score and Model for End-Stage Liver Disease score.

The research team found that cortisol response to corticotropin was negatively correlated with the severity of cirrhosis.

In addition, the mortality rate was higher in cirrhotic patients with relative adrenal insufficiency than in those without relative adrenal insufficiency.

The team noted that the cumulative 1-year survival rates in cirrhotic patients with and without relative adrenal insufficiency were 69% and 95%, respectively, while the corresponding cumulative 3-year survival rates were 0% and 95%.

Dr Sohn's team concludes, "Relative adrenal insufficiency is more commonly observed in those with severe cirrhosis, and is clearly associated with more advanced liver disease, and a shortened long-term survival."

"This suggests that relative adrenal insufficiency is an independent prognostic factor in non-critically ill patients with cirrhosis."

Aliment Pharmacol Ther 2014: DOI: 10.1111/apt.12891
04 August 2014

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