PRIMARY ADRENAL FAILURE AND AIDS - REPORT OF 11 CASES AND REVIEW OF THE LITERATURE

Objective. To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compar e the clinical manifestations with those reported in previous series i n the literature. Patients and methods. Retrospective study with revie w of clinical records of patients with AIDS diagnosed of AI (plasma co rtisol after synthetic ACTH < 18 mu g/dl) in our hospital for a period of 6 and a half years. Results. Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of A I in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.8 9 mu g/dl). Nine out of the 11 patients had a decreased basal plasma c ortisol level (mean: 4.75 mu g/dl). Basal plasma ACTH levels were incr eased (mean : 638.9 pg/ml) in seven out of nine patients. Patients wer e severely immunosuppressed (mean CD4: 21/mu l). While the clinical co urse was subacute (mean: 5.1 weeks), nine out of the eleven patients d eveloped an adrenal crisis which required emergency therapy. Ten patie nts had an opportunist infection -M. tuberculosis (3), M. avium-intrac ellulare (3), Cytomegalovirus (3), histoplasmosis (1)-which could invo lve the adrenal glands in ten patients. All patients responded to trea tment but their mean survival was 5.6 weeks. Conclusions. Although the prevalence of AI in our patients with AIDS was low (1.66%), it is imp ortant to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.