[Primary adrenal failure and AIDS: report of 11 cases and review of the literature].
OBJECTIVE
To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature.


METHODS
Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years.


RESULTS
Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks.


CONCLUSIONS
Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.
Baraia-Etxaburu Artetxe
J
J
Seccione de Enfermedades Infecciosas, Hospital de Basurto, Bilbao.
Astigarraga Aguirre
B
B
Elorza Olabegova
R
R
Teira Cobo
R
R
Yoldi Arrieta
A
A
Cisterna Cancer
R
R
Bustamante Murga
V
V
Santamaría Jauregui
J M
JM
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications*; D000305:Adrenal Cortex Hormones / Q000097:blood; D000307:Adrenal Gland Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones