How I Approach It: Adrenal Insufficiency in Cirrhosis

• Published in: The American journal of gastroenterology Vol. 117; no. 12; pp. 1889 - 1893
• Main Authors: Wentworth, Brian J., Henry, Zachary H., Siragy, Helmy M.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01-12-2022; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adrenal glands; Adrenal Insufficiency - complications; Adrenal Insufficiency - diagnosis; Gastroenterology; Hormones; Humans; Hydrocortisone; Hyponatremia; Hypotension; Illnesses; Immunoassay; Laboratories; Liver Cirrhosis - complications; Liver diseases; Longitudinal studies; Medical prognosis; Mortality; Patients; Steroids
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000001939

Cholesterol is delivered to the adrenal gland by hepatic-derived high-density lipoprotein (HDL); is transported across the mitochondrial membrane; and undergoes multiple enzymatic conversions into mineralocorticoids, glucocorticoids, and sex hormones. [...]AI is more frequently relative and seems to lack a distinctive phenotype (1). [...]a high index of suspicion is necessary, and clinicians should consider its presence when the underlying liver disease or acute illness itself incompletely explains patient symptoms or metabolic derangements. In critically ill patients, high-dose glucocorticoid therapy may be considered because a small case-control study demonstrated short-term benefits including resolution of septic shock and in-hospital survival (13). Infection risks remain high in this population, and a randomized clinical trial suggested that hydrocortisone-treated patients had increased rates of gastrointestinal bleeding and no difference in out-of-hospital mortality (14). [...]clinicians should exercise significant caution when prescribing glucocorticoids in critically ill patients with cirrhosis.