Low-dose adrenocorticotropin test in patients with the Acquired Immunodeficiency Syndrome

adrenocortical insufficiency is a serious complication of aids. usually, integrity of the hypothalamo-pituitary-adrenal (hpa) axis in aids patients is assessed by measuring basal cortisol levels and cortisol response to 250 mg of acth. recent studies suggest that a lower acth dose increases the sensitivity of the procedure. in the present study, we investigated the prevalence of adrenal hypofunction in aids patients using a low-dose acth test (1 mg), evaluated the clinical characteristics that might suggest this diagnosis, and the diseases and/or drugs that could be associated with it. we prospectively evaluated 63 very ill aids patients and 16 normal controls. a standard examination assessed the presence of signs and symptoms of adrenal insufficiency. blood samples were collected before and 30 and 40 minutes after an injection of 1 mg 1-24 acth. no opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to acth. the lowest stimulated cortisol level in the control group was 18.5 mg/dl; cortisol levels 318 mg/dl were taken to indicate a normal hpa axis. test results revealed that 12/63 aids patients (19%) had an abnormal hpa axis. with these data in mind, we suggest a prospective adrenal function evaluation of all severely ill aids patients.