       Document 0141
 DOCN  M9630141
 TI    Prevalence of cortisol deficiency in late HIV disease.
 DT    9603
 AU    Abbott M; Khoo SH; Hammer MR; Wilkins EG; Department of Genitourinary
       Medicine, Southport and Formby; District General Hospital, UK.
 SO    J Infect. 1995 Jul;31(1):1-4. Unique Identifier : AIDSLINE MED/96019116
 AB    In order to determine the prevalence of cortisol deficiency in advanced
       HIV disease and to examine whether it may be predicted by clinical
       features or biochemical abnormalities, we conducted a prospective study
       which assessed responses to a rapid ACTH stimulation test
       (short-duration synthetic corticotrophin test, synacthen test) in
       HIV-positive patients with a CD4 count of < or = 50 x 10(6)/l.
       Subjective fatigue, postural drop in blood pressure, electrolyte
       changes, presence of concurrent opportunist infection and drug treatment
       were recorded. Cortisol responses were defined as 'normal' (a post
       stimulation cortisol level > or = 450 nmol/l), 'abnormal' (post
       stimulation cortisol level < 350 nmol/l) or 'impaired' (an intermediate
       response). Of 49 patients tested (42 male, seven female), a suboptimal
       response (abnormal or impaired) was found in 14 (29%) and frank
       insufficiency in eight (16%). Cortisol deficiency was not predicted by
       postural drop in blood pressure, biochemistry or symptoms of fatigue.
       Patients with an impaired/abnormal test were not more likely to have
       cytomegalovirus or mycobacterial disease but were more likely to be
       taking megestrol acetate (P = 0.05, Fisher's exact test). Two of three
       patients with initially normal tests developed impaired/abnormal
       cortisol responses on re-testing 6-9 months later. Cortisol deficiency
       is common in late stage HIV disease, but symptoms of fatigue and
       postural hypotension, as well as biochemical findings, are poor
       predictors of cortisol deficiency. We found good subjective response to
       therapy. Routine screening by a rapid ACTH stimulation test is
       recommended in HIV-positive patients with CD4 count < or = 50 x 10(6)/l.
       Re-testing at regular intervals may be necessary. The interaction
       between megestrol acetate, cortisol metabolism and synacthen testing
       requires further investigation.
 DE    Adrenal Cortex/PHYSIOPATHOLOGY  Adult  Cosyntropin/DIAGNOSTIC USE  CD4
       Lymphocyte Count  Female  Human  Hydrocortisone/*DEFICIENCY  HIV
       Infections/*BLOOD/PHYSIOPATHOLOGY  HIV
       Seropositivity/BLOOD/PHYSIOPATHOLOGY  Male  Middle Age  Predictive Value
       of Tests  Prevalence  Prospective Studies  Time Factors  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

