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Cytomegaloviral adrenalitis and adrenal insufficiency in AIDS

U Pulakhandam1, H P Dincsoy

  • 1Department of Pathology, Kings County Hospital Center, Brooklyn, New York.

American Journal of Clinical Pathology
|May 1, 1990
PubMed

Insights

Cytomegalovirus (CMV) frequently infects adrenal glands in acquired immune deficiency syndrome (AIDS) patients. Diffuse CMV adrenalitis correlates with lower sodium-potassium ratios and impaired adrenal function, necessitating further testing.

Area of Science:

  • Pathology
  • Virology
  • Endocrinology

Background:

  • Acquired immune deficiency syndrome (AIDS) is associated with opportunistic infections.
  • Cytomegalovirus (CMV) is a common opportunistic pathogen in AIDS.
  • Adrenal gland involvement in AIDS patients with CMV is not fully characterized.

Purpose of the Study:

  • To determine the incidence and characteristics of CMV adrenalitis in autopsy cases of AIDS.
  • To correlate histological findings with clinical data and adrenal function.

Main Methods:

  • Review of 74 autopsy cases of AIDS.
  • Histological analysis of adrenal glands for CMV infection, inflammation, necrosis, and fibrosis.
  • Correlation of CMV scores and fibrosis scores with clinical data, including sodium-to-potassium (Na:K) ratio.
  • Adrenocorticotropic hormone (ACTH) stimulation tests in a subset of patients.

Main Results:

  • CMV infection was found in 50% of AIDS autopsy cases, with 84% of these affecting the adrenal glands.
  • Diffuse CMV adrenalitis was associated with higher CMV and fibrosis scores and a Na:K ratio < 30.
  • Focal CMV adrenalitis showed lower scores and a Na:K ratio > 30.
  • ACTH stimulation tests revealed blunted cortisol responses in patients with CMV adrenalitis.

Conclusions:

  • The adrenal gland is a frequent target of CMV infection in AIDS.
  • Histological patterns of CMV adrenalitis correlate with clinical markers like Na:K ratio.
  • Adrenal insufficiency may occur in CMV adrenalitis, warranting further investigation with ACTH tests in selected AIDS patients.

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