title: Assessment of adrenal function in liver diseases.
abstract: BACKGROUND
  In recent times, there are reports of adrenal dysfunction in whole spectrum of liver disease. Adrenal insufficiency (AI) has been shown to correlate with progression of liver disease. Hence this study was conducted to assess adrenal function in subjects with acute liver disease (ALD), chronic liver disease (CLD) and post liver transplantation (LT).
  
  
  METHODS
  This study included 25 healthy controls, 25 patients of ALD, 20 subjects of CLD with Child-Pugh stage A (CLD-1) and 30 with Child-Pugh stage B or C (CLD-2), and 10 subjects with LT. All subjects were assessed clinically, biochemically and for adrenal functions.
  
  
  RESULTS
  AI was present in 9 (34.6%) patients with ALD, 20 (40%) patients with CLD and 4 (40%) in subjects with LT. AI was more common in CLD-2 (18 patients - 60%) than CLD-1 (2 patients - 10%). All patients with chronic liver disease had significantly lower basal cortisol (8.8±4.8, P=0.01), stimulated cortisol (18.2±6.3, P <0.00001) and incremental cortisol (9.4±4.6, P <0.00001) as compared to controls. There was increase in percentage of subjects with adrenal dysfunction with progression of liver disease as assessed by Child-Pugh staging. AI was predicted by lower levels of serum protein, serum albumin, total cholesterol and HDL cholesterol and higher levels of serum bilirubin and INR. Adrenal functions showed recovery following liver transplantation.
  
  
  CONCLUSIONS
  AI forms important part of spectrum of acute and chronic liver disease. Deterioration of synthetic functions of liver disease predicts presence of AI, and these patients should be evaluated for adrenal dysfunction periodically.
authors.affiliation: Department of Endocrinology, Army Hospital (R&R), Delhi Cantonment, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kharb
authors.forename: M K
authors.initials: MK
authors.lastname: Garg
authors.forename: Pankaj
authors.initials: P
authors.lastname: Puri
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Nandi
authors.forename: Karninder S
authors.initials: KS
authors.lastname: Brar
authors.forename: Abhay
authors.initials: A
authors.lastname: Gundgurthi
authors.forename: Aditi
authors.initials: A
authors.lastname: Pandit
keywords: Acute liver disease; adrenal insufficiency; chronic liver disease; cortisol; liver transplantation