Hepato-Adrenal Syndrome is an underdiagnosed condition that is still incompletely understood but appear multifactorial. His prevalence can reach 72% in series of hospitalized patients for cirrhosis. change in protein homeostasis imposed by hypoalbuminemia induced by cirrhosis and the decrease in all globulin binding outside of SHBG tends to cause diagnostic doubts. We report the case of a patient with a viral cirrhosis at the stage of decompensation in whom we diagnosed a hepato-adrenal syndrome suggested by evocative clinical symptoms and associated to a refractory hyponatremia. The spectacular evolution under hydrocortisone led us to reiterate our diagnosis even before performing the adrenal stimulation test. We propose a review of literature that highlights the epidemiological, pathophysiological and diagnostic aspects of this pathological entity.