Clinical analysis of patients of cirrhosis complicated with adrenal insufficiency

OBJECTIVE: To evaluate the level of cortisol and adrenocorticotrophic hormone (ACTH) in patients with cirrhosis and to investigate the clinical significance and characteristics of cirrhosis with adrenal insufficiency (AI). PATIENTS AND METHODS: A total of 118 patients that were hospitalized in the Department of Gastroenterology of Xiangyang Hospital affiliated to Hubei University due to cirrhosis were selected and chemiluminescence assay was used to measure the basal level of cortisol and ACTH in their blood. All the 118 patients with cirrhosis were divided into two groups, cirrhosis with AI group and cirrhosis without AI group and comparison and analysis of the clinical characteristics and prognosis of the two groups were undertaken. About 39 patients with gastrointestinal polyps were used as control group. RESULTS: The basal level of cortisol of the patient group 329.67 +/- 136.1 nmol/l was significantly lower than that of the normal control 460.7 +/- 165.48 nmol/l (p<0.05). Of the 118 patients with cirrhosis, 32 patients had AI (32/118). Compared with the cirrhosis without AI group, cirrhosis with AI group had significantly increased spontaneous bacterial peritonitis (SBP), Child classes, Child scores, MELD scores and case fatality and the difference was statistically significant (p<0.05). The level of albumin and high-density lipoprotein-cholesterol (HDL-C) in 32 patients with cirrhosis and AI was significantly reduced and the prevalence rate of facial pigmentation and ascites were significantly higher (p<0.05). But, there was no statistically significant difference between cirrhosis with AI and cirrhosis without AI (p>0.05) in other clinical characteristics and laboratory parameters studied. CONCLUSIONS: The basal level of cortisol in patients with cirrhosis was significantly reduced and about 27% of cirrhosis patients had AI. Patients of the later kind had a higher prevalence rate of SBP, worse hepatic impairment and higher mortality, thus resulting in poor prognosis.