PRIMARY ADRENAL INSUFFICIENCY IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Background. - Lesions of adrenal glands are common findings at autopsy patients with acquired immunodeficiency syndrome (AIDS). lit contrast the diagnosis of symptomatic adrenal insufficiency is rarely establis hed during the lifetime of these these patients. Patients. - We report four new cases and review the literature. All four patients had full blown AIDS with a mean CD4 cell count of 19 mu/L. One or more opportun istic disease was present at the time of diagnostic: cytomegalovirus r etinitis two cases, disseminated Mycobacterium avium infection in two, Kaposi's sarcoma in two and Candida esophagitis in one. Results. - Th e clinical presentation constantly included fatigue, weight loss, seve re orthostatic hypotension and gastrointestinal disturbances. Cutaneou s hyperpigmentation was present in three cases. In most cases biologic al abnormalities were typical, such as hyponatremia, urinary Na/K rati o greater than or equal to 1, and hyperkalemia. Serum cortisol levels were within the range of normal in three cases but response to the cos yntropin challenge was typically impaired in all cases. Clinical and b iological manifestations returned to normal in 1 to 3 weeks after init iation of therapy with cortisol, associated to fludrocortisone in thre e cases. However, 13 months after diagnosis, three patients were dead. Conclusions. - Usually asymptomatic, diagnostic of symptomatic adrena l insufficiency must be suspected even when clinical presentation is a typical because rapid efficiency of hormonal treatment. (C) 1998, Else vier, Paris.