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Review: Adrenal Insufficiency in Liver Disease

Giuseppe Fede, Luisa Spadaro and Francesco Purrello

Adrenal Insufficiency (AI), defined as deficient production or action of glucocorticoids resulting from either a structural damage of adrenal glands (primary adrenal insufficiency) or an impairment of the hypothalamic-pituitary axis (secondary adrenal disease), is being reported with increasing frequency in patients with liver disease, and some authors proposed the term “hepato-adrenal syndrome”. The prevalence of AI in patients with liver disease varies widely according to the study population: critically ill patients (33-92%), stable cirrhosis (31-60%), or decompensated cirrhosis, such as variceal bleeding (30-48%) and ascites (26-64%). However there is no current consensus about diagnostic criteria to define AI in patients with liver disease, and its prognostic relevance in stable cirrhosis is still unclear.