Assessment of adrenal function by measurement of salivary steroids in response to corticotrophin in patients infected with human immunodeficiency virus.
OBJECTIVE
Adrenal insufficiency has been reported among critically ill HIV-infected patients. This is the first study that attempts to detect subclinical hypoadrenal states in non-critical HIV patients through salivary steroids in response to intramuscular low-dose ACTH injection.


METHODS
We studied 21 ambulatory adult HIV-infected patients without specific clinical signs or symptoms of adrenal insufficiency. Normal salivary flow-rate and salivary alpha-amylase activity confirmed adequate salivary gland function. Salivary cortisol (SAF) and salivary aldosterone (SAL) were obtained at baseline and 30 min after the injection of 25 microg of ACTH in the deltoid muscle (LDT(s)). Assessment of salivary steroids after stimulation with 250 microg of intramuscular ACTH (HDT(s)) was performed on those who hyporesponded to LDT(s). Basal blood samples were drawn for steroids, renin and ACTH measurements.


RESULTS
At baseline SAF and SAL correlated significantly (p=0.0001) with basal serum cortisol and aldosterone (r=0.70 and 0.91, respectively). Plasma ACTH and renin concentrations were within the normal range in all patients. Eight of the twenty-one HIV(+) patients were LDT(s) hyporesponders in either SAF (n:1) or SAL (n:7). LDT(s) repeated in six cases after a year reconfirmed the impairment of aldosterone secretion. LDT(s) hyporesponders had normal steroid responses to HDT(s).


CONCLUSIONS
LDT(s) is a simple, safe, well-accepted and non-invasive approach to assess adrenal function in HIV-infected ambulatory patients. It revealed subnormal cortisol (5%) and aldosterone responses (33%) when HDT(s) results were normal.
Cardoso
Estela
E
Endocrine Research Department, Instituto de Investigaciones Médicas A. Lanari, School of Medicine, University of Buenos Aires, Argentina. endoexp2000@yahoo.com
Persi
Gabriel
G
González
Natalia
N
Tumilasci
Omar
O
Arregger
Alejandro
A
Burgos
Myriam
M
Rodríguez
Viviana
V
Molina
Ana
A
Contreras
Liliana N
LN
D000302:Adrenal Cortex / Q000502:physiology*; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012463:Saliva / Q000378:metabolism*; D013256:Steroids / Q000097:blood / Q000378:metabolism*; D000516:alpha-Amylases / Q000378:metabolism
D013256:Steroids; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D000516:alpha-Amylases; D006854:Hydrocortisone