CLINICAL-FEATURES OF ADRENAL INSUFFICIENCY IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

OBJECTIVE Adrenal insufficiency (Al) is a well known complication of A IDS. However, the clinical and biochemical features of Al in HIV infec ted patients have not been extensively studied. DESIGN A restrospectiv e clinical study. PATIENTS We reviewed clinical records of 74 AIDS pat ients with clinical and/or biochemical indications of Al who underwent Synacthen testing in order to determine adrenocortical function durin g a 5-year period. MEASUREMENTS Al was diagnosed when cortisol levels failed to rise above 496 nmol/l at any time during the test. Cortisol was measured by RIA. RESULTS Sixteen patients (22%) were diagnosed wit h Al. Most were young males and all of them had a known risk factor, p rincipally i.v. drug users. The main complaint was fatigue. Hyponatrae mia or hyperkalaemia were uncommon. All of them were severely immunosu ppressed, with AIDS-defining conditions from at least 6 months before the diagnosis of Al, and had been diagnosed with at least one disease that has been reported to produce Al in AIDS patients. Survival was po or. Thirteen of these patients (81%) died within 6 months. Basal corti sol levels were lower than 275 nmol/l in 75% of patients with Al but i n only 2% of the group of 58 patients who had normal adrenal responses to Synacthen. CONCLUSIONS Adrenal insufficiency features in AIDS pati ents with advanced disease, without specific findings and with a histo ry of previous opportunistic diseases. Basal cortisol values at 0830 h lower than 275 nmol/l are highly suggestive of adrenal insufficiency in patients with AIDS.