The similarities between septic shock and liver failure led to the proposal of the term hepatoadrenal syndrome. This study aimed to evaluate children with liver cirrhosis for the presence of adrenal insufficiency especially during critical illness. It was designed to evaluate adrenal function for 24 children with liver cirrhosis of various etiologies by measuring basal cortisol level and measuring the peak level after 30 minutes of short low dose ACTH stimulation test. They were categorized to; group 1 included 12 patients with sepsis and group 2 included 12 patients without sepsis. It was found in this study that no one of group1or group 2 had absolute adrenal insufficiency; however 11 patients, 8 (66.6%) of group 1 and 3 patients (25%)of group 2 had relative adrenal insufficiency (RAI) as the increment detected in cortisol level after stimulation was < 9 µgm/dL. Most of patients with RAI (72.7%) were categorized as having Child -Pugh C liver cirrhosis. The presence of ascites, high temperature, high C reactive protein, neutrophilia, high ALT, AST, high total bilirubin, prolonged INR and lower albumin were all risk factors associated with the occurrence of RAI. Survival rate in patients with normal adrenal function (92%) was significantly better than in patients with RAI (27%) (p=0.02). It was concluded from this study that a high incidence of relative adrenal insufficiency was found in children with liver cirrhosis. It was more common in the presence of sepsis, related to the degree of liver cirrhosis and carried a bad prognosis.
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