Prevalence of Adrenal Insufficiency in Critically Ill Patients with AIDS
Vichit Prasanthai MD*, Sarat Sunthornyothin MD**, Prasit Phowthongkum MD*, Chusana Suankratay MD, PhD*
Affiliation : * Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University ** Division of Endocrinology, Department of Medicine, Faculty of Medicine, Chulalongkorn University
Background : The most common endocrine disorder in patients with human immunodeficiency virus (HIV) is
adrenocortical dysfunction. The prevalence of adrenal insufficiency in patients with AIDS is unclear, partly
due to different tests, doses of adrenocorticotrophic hormone (ACTH), and criteria used. In addition, there is
controversy regarding the assessment of adrenal insufficiency in patients with and without critical illness.
Objective : To help clarify the prevalence of adrenal insufficiency in patients with AIDS both in critical and
non-critical illness, the authors compared the prevalence based on the high-dose ACTH stimulation test.
Materials and Methods : There were 26 patients with AIDS (19 males and 7 females) with a mean age of 33.6
years (range: 22-46 years). Twelve and 14 patients were in critical and non-critical illness, respectively.
Result: Overall, the prevalence of adrenal insufficiency was 19.2% (5 of 26) and 30.8% (8 of 26) when a peak
stimulated cortisol level of < 18 μg/dL and < 25 μg/dL was defined, respectively. The prevalence was 8.3% and
28.6% in critically and non-critically ill patients; respectively, when a peak stimulated cortisol level of < 18
μg/dL was defined. Finally, when a peak stimulated cortisol level of < 25 μg/dL was defined, the prevalence
was 16.7% and 42.9% in critically and non-critically ill patients, respectively.
Conclusion : Adrenal insufficiency in patients with AIDS is more prevalent than those without HIV infection,
no matter what criteria of cortisol response after ACTH test are defined. An adrenal testing should be per-
formed in all hospitalized patients with AIDS, both in critical and non-critical illness.
Keywords : Adrenal insufficiency, AIDS, HIV, Critically ill, Adrenocorticotrophic hormone (ACTH) stimula- tion test
