Endocrine Abstracts

JOINT86

Introduction: Persistent hypotension and hyponatremia are common clinical features in patients with cirrhosis, for which an endocrine consult is not uncommon. Additionally, hypoalbuminemia is a common finding in cirrhosis, with reductions in total hormone assay levels, including cortisol, which leads to a false interpretation of hypocortisolemia. Whether or not there is truly an increased risk (or diagnosis) of hypoadrenalism in patients with underlying cirrhosis remains unknown.

Objectives: The primary objective of this study is to evaluate if cirrhosis is associated with a greater risk for adrenal insufficiency. Secondary objectives include comparing serum levels of albumin, total cortisol, and free cortisol between patients with (and without) cirrhosis, to assess for significant differences.

Methods: The study was performed as a retrospective cohort study, with data collated from TriNetX Global Collaborative Network, providing de-identified patient information from 143 healthcare organizations worldwide. Two cohorts were assessed in this study: Group A (patients with cirrhosis who have had a total cortisol measurement, n = 43, 786) and Group B (patients without cirrhosis who have had total cortisol measurements, n = 1, 249, 256). Propensity score matching was employed to allow for balancing between the cohorts with n = 53, 220; this was achieved by controlling for age, race, gender, body mass index, A1c, alcohol use, systemic corticosteroid use, and underlying inflammatory diseases of the liver.

Results: The results of this study noted no greater risk for primary, secondary, tertiary or drug-induced hypoadrenalism in patients with cirrhosis compared to those without, but rather a statistically significant (but likely clinically negligible) reduction in risk (Relative Risk 0.929, 95% CI: 0.872-0.99, P = 0.0239). Secondary outcomes noted a significantly lower mean albumin level in Group A (3.171 vs 3.58, P < 0.0001) but higher mean total cortisol (14.06 vs 12.188, P < 0.0001). There was no significant difference regarding free cortisol between both cohorts (P = 0.9822).

Conclusion: This study suggests that cirrhosis does not confer a greater risk for adrenal insufficiency (of any cause). As expected, patients with cirrhosis did demonstrate hypoalbuminemia, however, they appeared to overall exhibit higher mean total cortisol levels (without a significant difference in free cortisol). These findings support a cautious approach to adrenal function testing in patients with cirrhosis, and for reserving the diagnosis of adrenal insufficiency when there is true clinical suspicion.