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Adrenocortical function in acquired immunodeficiency syndrome.

L Membreno, I Irony, W Dere

    The Journal of Clinical Endocrinology and Metabolism
    |September 1, 1987
    PubMed
    Summary
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    Patients with acquired immunodeficiency syndrome (AIDS) show abnormal adrenal steroid levels. Subnormal responses to ACTH stimulation indicate potential future adrenal insufficiency in AIDS patients.

    Area of Science:

    • Endocrinology
    • Immunology
    • Virology

    Background:

    • Adrenal steroid deficiency can manifest clinically in patients diagnosed with acquired immunodeficiency syndrome (AIDS).
    • Assessing peripheral steroid levels is crucial for understanding adrenal function in HIV-infected individuals.

    Purpose of the Study:

    • To investigate the frequency of peripheral steroid level aberrations in patients with AIDS and AIDS-related complex (ARC).
    • To evaluate adrenal steroid responses to ACTH stimulation in these patient groups.

    Main Methods:

    • Measured plasma concentrations of cortisol, deoxycorticosterone, 18-hydroxydeoxycorticosterone (18-OHDOC), corticosterone, aldosterone, and 18-hydroxycorticosterone in 74 AIDS and 19 ARC patients.
    • Administered a 0.25 mg ACTH (Cosyntropin) bolus and a 3-day supraphysiological ACTH course.

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  • Assessed responses to Angiotensin III infusion and postural stimulation.

    • Main Results:

    • Basal cortisol levels were elevated in AIDS patients; however, 17-deoxypathway steroids (deoxycorticosterone, corticosterone, 18-OHDOC) were initially normal.
    • Subnormal increases in deoxycorticosterone, corticosterone, and 18-OHDOC were observed post-ACTH in both AIDS and ARC patients.
    • ARC patients exhibited higher 18-OHDOC levels than AIDS patients post-ACTH. Prolonged ACTH stimulation confirmed impaired steroid responses in AIDS patients.
    • Aldosterone and 18-hydroxycorticosterone responded normally to Angiotensin III and postural changes.

    Conclusions:

    • Defective stimulation of 18-OHDOC, alone or with other 17-deoxysteroids, may precede impaired adrenal capacity in AIDS.
    • These findings highlight potential adrenal dysfunction in the context of HIV infection.