title: Primary adrenal insufficiency in two patients with the acquired immunodeficiency syndrome associated with disseminated cytomegaloviral infection.
abstract: We present two patients with manifest acquired immunodeficiency syndrome (AIDS) suffering from a generalized cytomegalovirus (CMV) infection. Over the course of several weeks they had developed a state of increasing lethargy and fatigue and one patient had noticed a darkening of his skin. These and other symptoms (vomiting, diarrhoea, hypotension) were suggestive of adrenal insufficiency. Laboratory findings included an increase of serum potassium levels, a decrease of serum sodium concentrations and elevated levels of the adrenocorticotropic hormone (ACTH). These findings, as well as the prompt therapeutic response to hydrocortisone established the diagnosis of adrenal insufficiency. Although definitive proof is lacking, generalised CMV infection is the most likely cause of our patients' symptoms. For the early initiation of appropriate substitution therapy, persons infected with the human immunodeficiency virus (HIV) with signs of CMV infection should be carefully and repeatedly monitored for clinical and laboratory signs of adrenal insufficiency.
authors.affiliation: Department of Dermatology, University of Vienna, Medical School, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Geusau
authors.forename: G
authors.initials: G
authors.lastname: Stingl
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis*; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood
chemical_list: D000324:Adrenocorticotropic Hormone; D012964:Sodium; D011188:Potassium; D006854:Hydrocortisone