Low-dose adrenocorticotropin test in patients with the acquired immunodeficiency syndrome.
Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 microg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 microg), evaluated the clinical characteristics that might suggest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were collected before and 30 and 40 minutes after an injection of 1 microg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the control group was 18.5 microg/dL; cortisol levels > or = 18 microg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19%) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.
Wolff
F H
FH
Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
Nhuch
C
C
Cadore
L P
LP
Glitz
C L
CL
Lhullier
F
F
Furlanetto
T W
TW
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000503:physiopathology; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage*; D000328:Adult; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D011446:Prospective Studies
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone