Review: Adrenal Insufficiency in Liver Disease

Adrenal Insufficiency (AI) is defined as deficient production or action of glucocorticoids resulting from either a structural damage of adrenal glands, namely ‘‘primary adrenal insufficiency’’, or an impairment of the hypothalamic-pituitary axis or ‘‘secondary adrenal disease’’ [1]. Primary AI is rare in general population, with an annual incidence of approximately 6/million adults/year and prevalence of 40 to 110 cases/million adults [2] and autoimmune diseases are the most frequent causes in developed countries. Long-term glucocorticoid therapy is the most frequent cause of secondary AI, however any process that impairs the ability of the hypothalamic-pituitary axis to secrete ACTH can cause secondary adrenal insufficiency (i.e. Pituitary or suprasellar tumors).