Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Introduction: Liver cirrhosis represents a predisposing condition to adrenal insufficiency, and the coexistence of the two conditions seems to be associated with a poor prognosis (Bertino et al., 2016). In addition to critically ill cirrhotic patients, adrenal insufficiency has been reported in stable and decompensated cirrhosis without sepsis ( Fede et al ,2011 ) and in early and late post-liver transplantation (Trifan et al ,2013) Although adrenal insufficiency incidence is in line with the severity of cirrhosis, it exists in a wide range depending on the method used for diagnosis . (Thevenot et al., 2012; Rakici, 2017) Patients & methods: this study was conducted on 60 hemodynamically stable subjects without sepsis who were divided into three groups : {uF0B7} (Group A): this group included 30 patients with decompensated liver cirrhosis of different etiologies . {uF0B7} (Group B): which included 10 liver transplatation recipients due to liver cirrhosis {uF0B7} (Group C): which included 20 normal subjects as a control group All patients were underwnt thorough clinical examination then their routine laboratory investigations were assessed. MELD (model for end-stage liver disease) score and Child-Pugh classification for each patient were assessed.Adrenal gland functions were evaluated using standard dose-synacthen stimulation test ( SD-SST). 250 og of synthetic ACTH was injected intravenously then 2 blood samples were withdrawn after 30 and 60 minutes to measure serum cortisol level. Then serum total cortisol level was measured using the ADVIA Centaur® device at Kasr El Ainy chemical laboratory. Aim of study: was to evaluate adrenal insufficiency in hemodynamically stable decompensated cirrhotic patients without sepsis and in liver transplant recipients. Results: adrenal insufficiency was recorded in 11(27.5%) patients out of 40 stable liver cirrhotic patients and liver transplant recipients. Basal serum total cortisol level, serum cortisol level after 30 & 60 minutes of stimulation with 250og of ACTH and delta cortisol were all of lowest values among liver cirrhotic patients. AI incidence was inversely correlated with serum albumin level in stable liver cirrhotic patients of group A. There was statistically significant correlation of AI incidence with INR value and MELD score among liver cirrhotic patients

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