EC Clinical and Medical Case Reports

Many studies report increased prevalence of adrenal insufficiency (AI) as high as 65% among patients with liver cirrhosis based on measurement of total serum cortisol. However, in liver cirrhosis, the low concentrations of cortisol-binding globulin (CBG) and albumin may underestimate cortisol values leading to a false diagnosis of AI. Measurement of free serum cortisol, the biologically active fraction of cortisol, reflects adrenal function better than total cortisol. Four studies reported that attainment of a free cortisol value of 0.9 µg/dl either at baseline or after corticotropin stimulation rules out AI in patients with liver cirrhosis. Based on these data and until new guidelines are released, the author recommends the measurement of plasma free cortisol in addition to total cortisol to confirm the diagnosis of AI in patients with liver cirrhosis.

Keywords: Adrenal Insufficiency; Free Cortisol; Total Cortisol; Corticotropin

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