[Adrenal cortex and gonadal function in HIV infected patients]

Several studies have demonstrated diminished gonadal or adrenal function in patients infected with the human immunodeficiency virus (HIV). We have evaluated gonadal and adrenal function in 18 unselected ambulatory patients seropositive for HIV and clinically categorized as asymptomatic (n = 6), AIDS-related complex (ARC, n = 8) or acquired immunodeficiency syndrome (AIDS, n = 4). None of the patients was critically ill at the time of the hormone studies. Adrenal function was assessed using the 30 minute ACTH-test, and gonadal function by determination of the free testosterone serum level, both simple screening tests easily performable in practice. All male patients had normal free testosterone serum levels. In 5 (29%) of 17 patients (one asymptomatic, 3 with ARC, and 1 with AIDS) serum cortisol concentrations responded subnormally to synthetic ACTH, suggesting diminished adrenal cortisol reserve. The etiological role of the cytomegalovirus (CMV), which is said to be the most frequent cause of adrenal insufficiency in these patients, was unclear in our patients, because 4 of the 5 cases with the subnormal as well as 11 of the 12 with the normal test had antibodies against CMV in serum.