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Canadian Journal of Gastroenterology and Hepatology
Volume 2017, Article ID 2354253, 6 pages
Research Article

Evaluation of Adrenal Function in Nonhospitalized Patients with Cirrhosis

1Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Zand Street, Shiraz 71935-1311, Iran
2Department of Internal Medicine, Fasa University of Medical Sciences, Ebne Sina Square, Fasa, Iran
3Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence should be addressed to Maryam Moini; moc.liamtoh@manrod

Received 31 March 2017; Revised 9 June 2017; Accepted 4 July 2017; Published 24 July 2017

Academic Editor: Emmanuel Tsochatzis

Copyright © 2017 Maryam Moini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Patients with cirrhosis and advancing hepatic insufficiency may show various degrees of other organ malfunction, including brain, kidney, and lung. Several studies have also shown a high prevalence of adrenal insufficiency in cirrhotic patients that may cause hemodynamic instability. Materials and Methods. In this study we prospectively evaluated adrenal function in a population of nonhospitalized cirrhotic patients. Categorization of liver disease severity was done according to model for end-stage liver disease (MELD) score. Adrenocorticotropic hormone stimulation testing was performed on subjects using 250 μg of synthetic short acting hormone; radio immunoassay was used to measure plasma cortisol levels. Results. Of 105 cirrhotic patients, 15.23% had evidence of adrenal insufficiency. These patients were not statistically different from those with normal adrenal function in levels of serum creatinine or bilirubin, MELD score, or presence of cirrhosis related complications. Significant differences were seen in mean international normalized ratio and serum sodium. Patients with a sodium level < 135 mEq/L had a higher rate (31.25%) of adrenal insufficiency. Conclusion. Adrenal dysfunction was identified in a population of stable nonhospitalized cirrhotic patients. Our results suggest a possible role for adrenal dysfunction as a contributing factor in hyponatremia in cirrhosis independent of other known factors of neurohormonal activation secondary to systemic vasodilation.