Background: Adrenal insufficiency (AI) is recognized as a potential complication among individuals with liver cirrhosis, though its true prevalence and clinical importance are still subjects of ongoing discussion. Methods: We carried out this cross-sectional research on 60 adult patients with clinically and radiologically confirmed liver cirrhosis. They were classified into three equal groups based on Child-Pugh scores. Results: AI was found among 20% of cirrhotic patients. The AI prevalence increased significantly across Child-Pugh classes A, B, and C (0%, 5%, 55%; p < 0.001). Patients with AI had higher Child scores (mean 10.17 vs. 6.97, p < 0.001), higher MELD scores (median 17 vs. 9, p < 0.001), lower serum albumin (mean 2.58 vs. 3.23 g/dL, p < 0.001), and higher INR (mean 1.35 vs. 1.17, p = 0.039) than those with normal adrenal function. AI was significantly correlated with lower total cholesterol, HDL, LDL, and triglyceride levels (all p < 0.05). Multivariate regression analysis identified the Child score as the sole independent predictor for both morning (β = –1.56, p < 0.001) and evening cortisol levels (β = –0.54, p = 0.014). Serum cortisol correlated positively with systolic blood pressure, albumin, calcium, and lipid profile (all p < 0.05), while negatively with pulse, hepatic encephalopathy, ascites, Child and MELD scores, INR, PT, PTT, total bilirubin, creatinine, and BUN (all p < 0.05). Conclusion: Adrenal insufficiency was a common and under-recognized complication in cirrhotic patients, particularly in those with more advanced disease and impaired lipid profiles