Primary Addison's Disease in a Patient with the Acquired Immunodeficiency Syndrome

Guenthner, Elizabeth E.; Rabinowe, Steven L.; Niel, Anthony Van; Naftilan, Allen J.; Dluhy, Robert G.

doi:10.7326/0003-4819-100-6-847

Cited by 56 publications

(12 citation statements)

References 8 publications

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“…Electrolyte disor ders and diffuse hyperpigmentation which occur in hypoadrenalism have also been reported in patients with AIDS [3,4], Thus, physicians caring for patients with AIDS often consider the diagnosis of adrenal insufficien cy. Anecdotal reports of hypoadrenalism in patients with AIDS, early in the epidemic, added further support to the notion that adrenal insufficiency maybe a common occur rence in AIDS [5,6]. However, Membreno et al [7] found an incidence of only 5.4% of adrenal insufficiency in their evaluation of 74 patients with AIDS.…”

Section: Introductionmentioning

confidence: 84%

Glucocorticoid Reserve in Patients with Acquired Immunodeficiency Syndrome

Peter

Bruschetta²,

Vergara³

1995

Horm Res

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The purpose of the study was to determine the glucocorticoid reserve in patients with AIDS. Thirty patients with AIDS, who were not critically ill, were chosen consecutively and studied prospectively over a 1-year period with cosyntropin-stimulation testing. All patients showed normal glucocorticoid response to cosyntropin stimulation. Clinical adrenal insufficiency is uncommon in patients with AIDS who are not critically ill.

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Section: Introductionmentioning

confidence: 84%

Glucocorticoid Reserve in Patients with Acquired Immunodeficiency Syndrome

Peter

Bruschetta²,

Vergara³

1995

Horm Res

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“…In pre vious published studies of HIV-positive subjects, cortisol has been measured in plasma by radioimmunoassay and cross-reaction with cortisone has not been considered. This may explain variations in basal and stimulated corti sol levels in HIV-infected patients studied by different groups [1,7,9], It is difficult to be certain about the effects of AIDS on adrenal function because of the essential treatment and the effects of weight loss and severe illness on endocrine function which are known to influence cortisol metabo lism. Changes in the immune-HPA axis may arise from the selective changes in adrenal function during the course of HIV to AIDS.…”

Section: Discussionmentioning

confidence: 99%

“…At post-mortem, both acid-fast bacilli [ 1 ] and cytomegalo virus inclusion bodies have been demonstrated in the adrenal glands of patients with AIDS [2][3][4][5], Post-mortem evidence of pituitary infection with Toxoplasma gondii has also been reported [6]. In one study of 20 patients with AIDS who were undergoing evaluation of adrenal insuffi ciency, 4 had no glucocorticoid responses to synthetic adrenocorticotrophin (ACTH) [7], Singer reported three patients with Addison's disease, presenting with hypoglycaemia, of whom 2 were subsequently found to have AIDS [8].…”

Section: Introductionmentioning

confidence: 99%

Low Adrenal Androgens in Men with HIV Infection and the Acquired Immunodeficiency Syndrome

Honour¹,

Schneider²,

Miller

1995

Horm Res

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Using gas chromatography and mass spectrometry we have studied the ratios of steroid metabolites and 24-hour urinary steroid excretion rates in 37 men of whom 14 where positive for the human immunodeficiency virus (HIV; group A), while 9 had acquired immunodeficiency syndrome (AIDS; group B). Controls were sick non-AIDS patients admitted to an intensive care unit (ICU) and healthy volunteers. In groups A and B and the ICU controls, there was a reduction in the excretion of adrenal androgen metabolites and a reduced ratio of 5α to 5β androgen metabolites. These data suggest that adrenal androgens are removed in HIV and AIDS in a similar manner to other systemic illnesses. In group B patients and the sick controls, the ratios of cortisol to cortisone metabolites were raised compared with controls. Daily, total cortisol metabolite excretion rates in AIDS were similar to those in patients in the ICU. The selective loss of adrenal androgens may be mediated by cytokines and influence components of the immune system. The progression of HIV to AIDS may be due in part to an imbalance between androgens and glucocorticoids.

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“…A third basis for the occurrence of hyponatremia is adrenal dysfunction. A number of re ports have documented adrenal involvement in AIDS patients, including frank adrenal insufficiency [11][12][13]. Many patients with AIDS will exhibit subnormal re sponses to Cortrosyn® stimulation, and a spectrum of adrenal steroid biosynthetic abnormalities has been identified in patients hospitalized with AIDS at San Francisco General Hospital [14,15].…”

Section: Fluid and Electrolyte Abnormalities In Aidsmentioning

confidence: 99%