Thesis (Ph.D.) - Cairo University - Faculty of medicine - Department of Internal Medicine

Background: Chronic liver diseases and cirrhosis are now being recognized as an important cause of morbidity and mortality world-wide. Critical illnesses are accompanied by the activation of the hypothalamic-pituitary-adrenal (HPA) axis.Recent studies have reported that patients with severe sepsis and septic shock commonly have abnormalities in adrenal function with a blunted response to adrenal stimulation. This condition has been termed relative adrenal insufficiency (RAI). Given the similarities between septic shock and liver failure, a number of groups have now studied the incidence of RAI in various forms of liver disease.Many studies also showed that the severity of adrenal insufficiency correlates to the severity of the liver disease. Objective: The aim of work in this study is to assess the incidence of RIA (relative adrenal insufficiency) among a group of Egyptian patients with liver cirrhosis and also to correlate the degree of adrenal affection to different grades of liver cirrhosis and also to various complications of liver cirrhosis. Methods: The study was conducted on two groups: Group 1 included 50 patients with liver cirrhosis and group 2 included 10 normal subjects as a control.All patients had been subjected to thorough history taking, clinical examination, blood sample for CBC, Liver and kidney fuctions tests, and abdominal ultrasound.. All patients had been subjected to SST( short synacthen test) using 250 ug of synthetic ACTH after admission with two blood samples for serum cortisol level taken before and 60 minutes after synacthen administration. Results: 9 patients had baseline cortisol <10og/dL(18%), 17 patients had a subnormal response with peak cortisol <18og/dL (34%) and 44 patients had a subnormal response with delta cortisol <9og/dL(88%)

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