Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients.
BACKGROUND
Prevalence of adrenal insufficiency (AI) is not uncommon in HIV infected population. However, AI is rarely diagnosed in clinical practice because many patients have non-specific symptoms and signs. Critical illness in such patients further complicates the evaluation of adrenal function. A 1μgm ACTH test can be used for diagnosis, since it results in more physiological levels of ACTH. A serum cortisol of <18 μg/dL, 30 or 60-minutes after ACTH test has been accepted as indicative of AI, but many experts advocate the normal cortisol response should exceed 25 μg/dL, in critically ill patients.


OBJECTIVE
To determine the prevalence of AI in critically ill AIDS patients, by using 1 μg ACTH test and also, to compare the diagnostic criteria for adrenal insufficiency between cortisol response of <18 μg/dL and <25 μg/dL.


METHODS
This prospective study was done in the Department of Medicine.


METHODS
After taking blood for basal plasma cortisol from AIDS affected fifty adult men and women aged over 18 yrs, 1 μg ACTH was given intravenously, and blood samples were again collected at 30 and 60 minutes for plasma cortisol estimation.


METHODS
It was done by Mann-Whitney test.


RESULTS
Prevalence of AI was 74% (37 patients) and 92% (46 patients), when the peak stimulated cortisol level of <18 μg/dL and <25 μg/dL, respectively, was used.


CONCLUSIONS
AI is more prevalent in critically ill AIDS patients. Hence, this test can be performed for early intervention and better management.
Department of Medicine, S. Nijalingappa Medical College, Bagalkot, Karnataka, India.
P K
PK
Shashidhar
G V
GV
Shashikala