cosyntropin and Cytomegalovirus-Infections

Adrenal insufficiency is known to be a complication of HIV infection, although estimates of its prevalence and severity vary. Adrenal insufficiency is the most serious endocrine complication that occurs in persons with HIV infection. Patients with acquired immune deficiency syndrome (AIDS) are considered to be at high risk for primary or secondary adrenal insufficiency. We describe 3 patients with AIDS who had clinical features suggestive of adrenal insufficiency, but their corticotropin (ACTH) stimulation tests were normal. Repeat testing confirmed the diagnosis in one patient, and further testing with the overnight metyrapone test revealed evidence of secondary adrenal insufficiency in the other patients. Persistent clinical improvement was evident on subsequent glucocorticoid therapy. A normal response to the ACTH stimulation test can be dangerously misleading. Patients with AIDS and suspected adrenal insufficiency who have normal screening by the ACTH stimulation test should undergo further testing for secondary adrenal disease.

Topics: Adrenal Glands; Adrenal Insufficiency; Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Combined Modality Therapy; Cosyntropin; Cytomegalovirus Infections; Dexamethasone; False Negative Reactions; Fluid Therapy; HIV Infections; Humans; Hydrocortisone; Hypoglycemia; Insulin; Male; Metyrapone; Mycobacterium avium-intracellulare Infection; Pituitary Gland; Pituitary-Adrenal System; Risk; Sarcoma, Kaposi; Stomach Neoplasms

Topics: Acquired Immunodeficiency Syndrome; Adrenal Glands; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; AIDS-Related Opportunistic Infections; Aldosterone; Corticotropin-Releasing Hormone; Cosyntropin; Cytomegalovirus Infections; Humans; Hydrocortisone; Hyponatremia; Male; Middle Aged; Tomography, X-Ray Computed

Disseminated infections with cytomegalovirus have become an increasingly important cause of morbidity and mortality in patients with the acquired immune deficiency syndrome. Herein we describe a male homosexual with the acquired immune deficiency syndrome who became severely hyponatremic during bowel preparation for colonoscopy. Biochemical evidence of adrenal insufficiency and clinical evidence for cytomegalovirus colitis was found. We propose that the patient had clinically significant cytomegalovirus adrenalitis. A random urinary sodium concentration is suggested as a potential screening test before bowel preparation in such patients.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Gland Diseases; Adrenal Insufficiency; Adult; Bisacodyl; Colonoscopy; Cosyntropin; Cytomegalovirus Infections; Diet; Enema; Homosexuality; Humans; Hyponatremia; Inflammation; Male