A preliminary report on basal & stimulated plasma cortisol in patients with acquired immunodeficiency syndrome

Background & objectives; Structural and/or functional alterations in adrena l glands have been reported in human immunodeficiency virus (HIV) infection . However no information has been reported from India. Hence a study was un dertaken to assess the basal and circadian variations in plasma cortisol, a nd cortisol response to bolus ACTH in patients with AIDS. Methods : Basal and stimulated plasma cortisol levels at 0800 h and 1600 h and, at 30 and 60 min following an intravenous bolus of 250 mug ACTH (short synacthen test, SST) were estimated in 15 patients with AIDS (CD4 less tha n or equal to 200/mul) and 12 healthy controls. The nature of thr: opportun istic infections and/or associated disease in each patient was also studied . Results : The patients had higher median basal plasma cortisol levels as co mpared to the controls at 0800 h (540 nmol/l vs 415 nmol/l, P<0.005) and at 1600 h (420 nmol/l vs 285 nmol/l, P<0.003). Five patients (33%) exhibited abnormal circadian cortisol rhythms. All subjects in the control group and ail but one (6.6%) in the patients group had normal peak plasma cortisol re sponse (greater than or equal to 550 nmol/l to SST. The lone patient with s ubnormal cortisol response had no feature of adrenal insufficiency. On the contrary, 3 patients clinically suspected to have adrenal insufficiency, ha d normal plasma cortisol response. Interpretation & conclusions : These findings suggest that most patients wi th AIDS have elevated basal plasma cortisol levels with abnormal circadian rhythm in some and normal adrenocortical reserve irrespective of the sympto ms/signs of adrenal insufficiency.