Adrenal Insufficiency as a Cause of Acute Liver Failure: A Case Report

Abstract

Introduction. Many diseases and conditions can contribute to elevated liver enzymes. Common causes include viral and autoimmune hepatitis, fatty liver, and bile duct diseases, but, in uncommon cases like liver involvement in endocrine disorders, liver failure is also seen. Adrenal insufficiency is the rarest endocrine disorder complicating the liver. In the previously reported cases of adrenal insufficiency, mild liver enzymes elevation was seen but we report a case with severe elevated liver enzymes and liver failure due to adrenal insufficiency. Based on our knowledge, this is the first report in this field. Case Report. A 39-year-old woman was referred to emergency ward due to drowsiness and severe fatigue. Her laboratory tests revealed prothrombin time: 21 sec, alanine aminotransferase (ALT): 2339 IU/L, aspartate aminotransferase (AST): 2002 IU/L, and ALP: 90 IU/L. No common cause of liver involvement was discovered, and eventually, with diagnosis of adrenal insufficiency and corticosteroid therapy, liver enzymes and function became normal. Finally, the patient was discharged with good general condition. Conclusion. With this report, we emphasize adrenal insufficiency (primary or secondary) as a reason of liver involvement in unexplainable cases and recommend that any increase in the liver enzymes, even liver failure, in these patients should be observed.

Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge

“…However, our patient developed a progressive mixed cholestatic and hepatitic deterioration in LFTs with values of ALT, ALP and GGT over fivefold the upper limit of normal, and in the face of this decline, rifampicin was not restarted. Although our patient's hepatitis may have been secondary to adrenal insufficiency, it is rarely this severe 7. Moreover, in spite of 3 days of corticosteroid therapy and cessation of rifampicin, his LFTs continued to worsen.…”

“…Moreover, in spite of 3 days of corticosteroid therapy and cessation of rifampicin, his LFTs continued to worsen. In previous cases of Addisonian hepatitis, LFTs began to normalise shortly after starting corticosteroids 7. Therefore, it was felt that hepatitis secondary to adrenal insufficiency was unlikely, and other hepatotoxic medication was changed; specifically, isoniazid and pyrazinamide were substituted for streptomycin and moxifloxacin.…”

Relação entre a infecção por Helicobacter pylori e doenças metabólicas: uma revisão integrativa

“…Refaeli et al 14 , através da análise de dados de 147.936 pessoas, concluiram que pessoas infectadas com a bactéria tinham uma maior prevalência de SM em comparação com as não infectadas. Além disso os autores demonstraram que tanto a infecção como a erradicação da H. pylori pode interferir nos níveis de grelina e leptina, que são hormônios envolvidos na homeostase metabólica 14,15,50 .…”

Jaundice and pregnancy

“…3,4 Addison disease has also been associated with elevated hepatic transaminases in 16 published cases, reversing with glucocorticoid replacement. 5 In excluding Addison disease, the physiological rise in cortisol during pregnancy must be considered using trimester-specific reference ranges for short synacthen testing. 6 In the pregnant woman with unexplained liver disease and fever, acyclovir should be administered empirically, given the absence of cutaneous vesicles in up to 80% of affected patients and the extreme maternal and fetal mortality associated with untreated herpes simplex virus hepatitis.…”

“…Addison disease is a rare but potentially life‐threatening condition that may imitate hyperemesis gravidarum in presenting with vomiting, weight loss, postural hypotension and hyponatraemia . Addison disease has also been associated with elevated hepatic transaminases in 16 published cases, reversing with glucocorticoid replacement . In excluding Addison disease, the physiological rise in cortisol during pregnancy must be considered using trimester‐specific reference ranges for short synacthen testing .…”