Tijdschrift voor Geneeskunde vol:65 issue:6 pages:226-230
Relative adrenal insufficiency (RAI) signifies that the degree of the cortisol increase is not in proportion to the degree of inflammation and insufficient to maintain homeostasis in organ systems. Whether a treatment of RAI with corticosteroids decreases mortality, is still being debated.
RAI may also be observed in patients with liver failure and no evidence of sepsis, leading to the term "hepato-adrenal syndrome". Its prevalence varies from 33% in acute liver failure to 65% in chronic liver disease. RAI contributes to the haemodynamic instability and death of patients with liver disease and constitutes a possible indication for treatment. At the present time no sufficiently controlled data do exist to recommand the use of cortico- steroids in patients with liver failure.
Finally, a better definition of RAI in patients with advanced liver disease, is needed.