학술논문
Low-dose adrenocorticotropin test in patients with the acquired immunodeficiency syndrome.
Document Type
Academic Journal
Author
Wolff FH; Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.; Nhuch C; Cadore LP; Glitz CL; Lhullier F; Furlanetto TW
Source
Publisher: Elsevier Editora Country of Publication: Brazil NLM ID: 9812937 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1413-8670 (Print) Linking ISSN: 14138670 NLM ISO Abbreviation: Braz J Infect Dis Subsets: MEDLINE
Subject
Language
English
ISSN
1413-8670
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.