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M9630141.TXT
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1996-02-27
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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).