Relative Adrenal Insufficiency Among the Egyptian Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Al Alfy, Mohamed Noshy; Salem, Ayman Mohamed; Shaheen, Mohamed Ahmed Anwar; Abd El Ghany, Ahmed El Shabrawy

doi:https://doi.org/10.21608/aimj.2025.446503

Relative Adrenal Insufficiency Among the Egyptian Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Document Type : Case Series

Authors

¹ Professor of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

² Lecturer of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

³ Lecturer of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

⁴ MBBCh, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

https://doi.org/10.21608/aimj.2025.446503

Abstract

Abstract

Background: A prevalent complication in advanced Cirrhosis is spontaneous bacterial peritonitis (SBP), an infection of the ascitic fluid, where bacteria typically enter the peritoneal cavity without an apparent intra-abdominal surgically treatable source. This complication significantly escalates the risk of hospitalization and mortality, making it a critical area of study.
Aim and objectives: To assess the prevalence of relative adrenal insufficiency(RAI) among Egyptian cirrhotic patients with SBP.
Patients and methods: At Sayed Galal University Hospital, researchers conducted the investigation. A total of 90 patients of both genders, all of them diagnosed with cirrhosis, were referred to the Internal Medicine Department at Sayed Galal University Hospital. Patients were divided into two groups: Patients with compensated liver disease(diagnosed clinically, lab tests, and abdominal ultrasound). Patients with liver cirrhosis and SBP have polymorph nuclear leukocytes>250 cells/c.c.
Results: A statistically significant(P=0.004) increased percentage of patients with RAI in the SBP group(35 patients, 77.8%) when compared with that of the cirrhosis group(22 patients, 48.9%).
Conclusion: Our study demonstrates a significant association between liver disease progression and RAI among cirrhotic patients, particularly in the presence of SBP. Adrenal function, as assessed by basal and post-ACTH cortisol levels, was significantly impaired in SBP patients compared to those with stable Cirrhosis, with 77.8% of the SBP group showing RAI insufficiency versus 48.9% in the cirrhosis group. These findings underscore the critical impact of infection and systemic inflammation on adrenal responsiveness in cirrhotic patients, emphasizing the need for early detection and management of adrenal insufficiency, particularly in those with advanced disease or complications like SBP.

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