Adrenal Insufficiency in Cirrhosis: Don ’t Forget the Hypothalamus

We read with interest the recent article reporting a very high rate of relative adrenal insufficiency (RAI) in patients with cirrhosis admitted to the hospital with acute decompensation.1 We would like to add to their hypothesis that adrenal insufficiency in cirrhosis is caused by adrenal hypoperfusion and impaired substrates for steroidogenesis evidenced by reduced total cholesterol, high-density lipoprotein, and apolipoprotein A1 in patients with RAI. Although RAI may be multifactorial, we previously showed that adrenal insufficiency in patients with advanced cirrhosis predominantly is the result of a defect in the hypothalamic-pituitary-adrenal axis as opposed to an intrinsic adrenal gland defect.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research