Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome

Abstract

Adrenal insufficiency (AI) is a well known complication of AIDS. However, the clinical and biochemical features of AI in HIV infected patients have not been extensively studied. A retrospective clinical study. We reviewed clinical records of 74 AIDS patients with clinical and/or biochemical indications of AI who underwent Synacthen testing in order to determine adrenocortical function during a 5-year period. AI was diagnosed when cortisol levels failed to rise above 496 nmol/l at any time during the test. Cortisol was measured by RIA. Sixteen patients (22%) were diagnosed with AI. Most were young males and all of them had a known risk factor, principally i.v. drug users. The main complaint was fatigue. Hyponatraemia or hyperkalaemia were uncommon. All of them were severely immunosuppressed, with AIDS-defining conditions from at least 6 months before the diagnosis of AI, and had been diagnosed with at least one disease that has been reported to produce AI in AIDS patients. Survival was poor. Thirteen of these patients (81%) died within 6 months. Basal cortisol levels were lower than 275 nmol/l in 75% of patients with AI but in only 2% of the group of 58 patients who had normal adrenal responses to Synacthen. Adrenal insufficiency features in AIDS patients with advanced disease, without specific findings and with a history of previous opportunistic diseases. Basal cortisol values at 0830 h lower than 275 nmol/l are highly suggestive of adrenal insufficiency in patients with AIDS.