Prevalence of adrenal insufficiency in critically ill patients with AIDS.
BACKGROUND
The most common endocrine disorder in patients with human immunodeficiency virus (HIV) is adrenocortical dysfunction. The prevalence of adrenal insufficiency in patients with AIDS is unclear; partly due to different tests, doses of adrenocorticotrophic hormone (ACTH), and criteria used. In addition, there is controversy regarding the assessment of adrenal insufficiency in patients with and without critical illness.


OBJECTIVE
To help clarify the prevalence of adrenal insufficiency in patients with AIDS both in critical and non-critical illness, the authors compared the prevalence based on the high-dose ACTH stimulation test.


METHODS
There were 26 patients with AIDS (19 males and 7 females) with a mean age of 33.6 years (range: 22-46 years). Twelve and 14 patients were in critical and non-critical illness, respectively.


RESULTS
Overall, the prevalence of adrenal insufficiency was 19.2% (5 of 26) and 30.8% (8 of 26) when a peak stimulated cortisol level of < 18 microg/dL and < 25 microg/dL was defined, respectively. The prevalence was 8.3% and 28.6% in critically and non-critically ill patients; respectively, when a peak stimulated cortisol level of < 18 microg/dL was defined. Finally, when a peak stimulated cortisol level of < 25 microg/dL was defined, the prevalence was 16.7% and 42.9% in critically and non-critically ill patients, respectively.


CONCLUSIONS
Adrenal insufficiency in patients with AIDS is more prevalent than those without HIV infection, no matter what criteria of cortisol response after ACTH test are defined An adrenal testing should be performed in all hospitalized patients with AIDS, both in critical and non-critical illness.
Prasanthai
Vichit
V
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Sunthornyothin
Sarat
S
Phowthongkum
Prasit
P
Suankratay
Chusana
C
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000453:epidemiology*; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000453:epidemiology*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D015658:HIV Infections / Q000150:complications; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D013785:Thailand / Q000453:epidemiology
D000324:Adrenocorticotropic Hormone