Adrenal disease is an uncommon manifestation of hepatitis C infection and its related treatment regimen. This is a case of subclinical hypoadrenalism, probably induced by hepatitis C infection and further exacerbated by interferon-α2β and Ribavirin therapy. The adrenal deterioration during the treatment course was observed closely with 24-hour salivary profiles and 250 μg adrenocorticotropin stimulation tests using parallel serum and salivary cortisol concentrations. A number of possible pathogenic mechanisms are discussed, and the controversy over its management is emphasized. Case presentationA 55 year old post menopausal Caucasian female presented with vitiligo on her face, arms and legs. Her past medical history included only mild asthma requiring only intermittent bronchodilators without glucocorticoids. There was no other significant personal or family medical history. Clinical examination showed a well woman, weight of 69.1 kg, height 1.67 metre (body mass index 25). Her blood pressure was 120/75 lying and 120/70 sitting with a regular pulse of 78 beats per minute. RR, 80-1040), plasma renin activity > 35.7 ng/mL/hr (RR, 1.2-2.8). In essence, they showed mild hyperkalaemic metabolic acidosis and hepatocellular dysfunction. Because the latter persisted, chronic hepatitis C was confirmed with positive serology of genotype 1. The liver biopsy showed changes consistent with chronic persistent hepatitis, the inflammatory and fibrotic changes were both graded 1 according to the scoring method [1].