Low-dose adrenocorticotropin test in patients with the Acquired Immunodeficiency Syndrome

Abstract

Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 microg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 microg), evaluated the clinical characteristics that might suggest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were collected before and 30 and 40 minutes after an injection of 1 microg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the control group was 18.5 microg/dL; cortisol levels > or = 18 microg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19%) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.

Basal Cortisol Levels and Correlates of Hypoadrenalism in Patients with Human Immunodeficiency Virus Infection

“…In this study, using a cortisol cutoff level of 400 nmol/l, the prevalence of 27% for hypoadrenalism is higher than 19% reported in a recent Ugandan study [8] and 19% in a Brazilian study [14] . The reasons for our higher prevalence of hypoadrenalism in comparison with the Ugandan study [8] which comprised 113 patients and the Brazilian study [14] which included 63 HIV-positive patients is not obvious.…”

“…The reasons for our higher prevalence of hypoadrenalism in comparison with the Ugandan study [8] which comprised 113 patients and the Brazilian study [14] which included 63 HIV-positive patients is not obvious. The high prevalence of CMV infection in our patients (n = 66/66) may have contributed to our relatively high prevalence of hypoadrenalism.…”

“…The high prevalence of CMV infection in our patients (n = 66/66) may have contributed to our relatively high prevalence of hypoadrenalism. CMV infection was documented in 8.3% of the Brazilian study [14] , but its frequency was not reported in the Ugandan study [8] .…”

Endocrinopathies in Children Infected with Human Immunodeficiency Virus

“…15,16 However, patients with advanced disease may also develop cortisol resistance, leading to clinical signs of adrenal insufficiency in the face of normal or increased basal cortisol levels. Symptomatic and advanced disease in adults can frequently result in diminished response to corticotropin-releasing hormone, adrenocorticotropic hormone (ACTH) deficiency, or primary adrenal insufficiency 4,15,17 ; data in children are scarce.…”

Adrenal function in 23 children with paracoccidioidomycosis

“…Some authors have demonstrated similar results with low and standard doses (1 and 250 µg), suggesting that a lower dose of ACTH is enough to diagnose sub clinical adrenal insufficiency 10,21 . Other authors have found a greater frequency of primary adrenal dysfunction in patients with Acquired Immunodeficiency Syndrome using low doses in comparison to other studies that used standard doses 23 . In this study we demonstrated adrenal reserve in all patients, but we don't know if the results would be the same with a low dose of ACTH.…”