Functional adrenal insufficiency among critically ill patients with human immunodeficiency virus in a resource-limited setting.
BACKGROUND
Functional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness.


METHODS
After screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with FAI.


RESULTS
Functional adrenal insufficiency, defined in this study as morning total serum cortisol level of <or= 25 microg/dl, was detected in 21 (19%) of 113 patients (95% CI 11-26%). Eosinophilia (>3%) occurred in 52% (11 of 21) patients with FAI compared to 24% (22 of 92) patients with normal adrenal function (p= 0.01). Factors predicting FAI on multivariate analysis were use of rifampicin and eosinophilia. The mortality rate among patients with FAI (19%) was not significantly different when compared to that among patients with a normal cortisol response (33%) (p=0.221). Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study.


CONCLUSIONS
The diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies to determine benefits of corticosteroids in critically ill HIV patients are needed in this setting.
Meya
David B
DB
Infectious Disease Institute, Makerere University, Faculty of Medicine, Kampala, Uganda. david.meya@gmail.com
Katabira
Elly
E
Otim
Marcel
M
Ronald
Allan
A
Colebunders
Robert
R
Njama
Denise
D
Mayanja-Kizza
Harriet
H
Whalen
Christopher C
CC
Sande
Merle
M
D000305:Adrenal Cortex Hormones / Q000032:analysis / Q000378:metabolism; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D016638:Critical Illness; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004802:Eosinophilia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D004791:Enzyme Inhibitors; D012293:Rifampin