[Peripheral adrenal insufficiency in AIDS].
BACKGROUND
Lesions of adrenal glands are common findings at autopsy of patients with acquired immunodeficiency syndrome (AIDS). In contrast the diagnosis of symptomatic adrenal insufficiency is rarely established during the lifetime of these patients.


METHODS
We report four new cases and review the literature. All four patients had full blown AIDS with a mean CD4 cell count of 19 mu/L. One or more opportunistic disease was present at the time of diagnostic: cytomegalovirus retinitis in two cases, disseminated Mycobacterium avium infection in two, Kaposi's sarcoma in two and Candida esophagitis in one.


RESULTS
The clinical presentation constantly included fatigue, weight loss, severe orthostatic hypotension and gastrointestinal disturbances. Cutaneous hyperpigmentation was present in three cases. In most cases biological abnormalities were typical, such as hyponatremia, urinary Na/K ratio > or = 1, and hyperkalemia. Serum cortisol levels were within the range of normal in three cases but response to the cosyntropin challenge was typically impaired in all cases. Clinical and biological manifestations returned to normal in 1 to 3 weeks after initiation of therapy with cortisol, associated to fludrocortisone in three cases. However, 13 months after diagnosis, three patients were dead.


CONCLUSIONS
Usually asymptomatic, diagnostic of symptomatic adrenal insufficiency must be suspected even when clinical presentation is atypical because rapid efficiency of hormonal treatment.
Service des maladies infectieuses, hôpital Saint-Louis, Paris.
M X
MX
Dore
A
A
de La Blanchardière
P
P
Lesprit
F
F
David
J P
JP
Beressi
J
J
Fiet
D
D
Sicard
J M
JM
Decazes
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000209:etiology; D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology; D005438:Fludrocortisone / Q000627:therapeutic use; D018451:Homosexuality, Male; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000627:therapeutic use; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000209:etiology; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000209:etiology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000209:etiology; D019966:Substance-Related Disorders / Q000150:complications
D000893:Anti-Inflammatory Agents; D008901:Mineralocorticoids; D005438:Fludrocortisone; D006854:Hydrocortisone
Insuffisance surrénale périphérique au cours du SIDA.