Low-dose adrenocorticotropin test in patients with the acquired immunodeficiency syndrome

• Published in: The Brazilian journal of infectious diseases 2001-04, Vol.5 (2), p.53-59
• Main Authors: Wolff, F H, Nhuch, C, Cadore, L P, Glitz, C L, Lhullier, F, Furlanetto, T W
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - physiopathology; ACTH; Adolescent; adrenal insufficiency; Adrenal Insufficiency - diagnosis; Adrenal Insufficiency - epidemiology; Adrenal Insufficiency - etiology; Adrenocorticotropic Hormone - administration & dosage; Adult; AIDS; Case-Control Studies; cortisol; Diagnosis, Differential; Dose-Response Relationship, Drug; Female; Humans; Hydrocortisone - blood; INFECTIOUS DISEASES; Male; Middle Aged; Pituitary-Adrenal Function Tests; Prospective Studies
• ISSN: 1413-8670; 1678-4391; 1413-8670
• DOI: 10.1590/S1413-86702001000200002

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.