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A Study of Clinical and Biochemical Profile of Adrenal Insufficiency in AIDS Patients

Shashikala GV, Shashidhar PK, Umakant Boke, Gopal Bajaj, Pramiladevi R, and GB Doddamani

Most common and clinically relevant endocrine organ dysfunction in AIDS patients is that of adrenal cortex. But, adrenal insufficiency (AI) is seldom diagnosed in clinical practice because symptoms do not appear until more than 90% of the gland has been destroyed and symptoms suggestive of adrenal insufficiency are not uncommon in patients of AIDS without AI. There is lack of studies to look for characteristic features in such group, which can raise a suspicion and lead us to do biochemical evaluation, to detect early HPA axis involvement, to prolong as well as improve quality of life. Fifty HIV seropositive patients were selected, detailed history, clinical examination and biochemical parameters were recorded. Their basal cortisol and 30-min, 60-min, post synacthen test were performed, based on which the patients were grouped as AIDS with AI (AIDS-Ab) and AIDS without AI (AIDS-N) .The clinical feature and laboratory findings of these two groups were compared and interpreted using Chi square test as a test of significance and for comparison of laboratory data the Mann Whitney was used. In our study, in comparison to AIDS-N, AIDS-Ab patients had more frequency of weakness, weight loss, fever, gastrointestinal disturbances like nausea, vomiting. They also had lower range of CD4 count, hypoglycemia, high ESR, eosinophilia, hyponatremia, hyperkalemia, low Na/K ratio. In AIDS patients, symptoms like significant weight loss, low CD4 count, not on ART, hypoglycemia, increased ESR, hyponatremia, hyperkalemia, low Na/K ratio, low basal plasma cortisol levels as seen in the present study, should direct us in suspecting the risk of patient going for AI. In such patients stimulation tests could be done to confirm AI. The importance of early detection becomes clear from the fact that AI adds to the mortality of AIDS patient, and also early intervention in such patients prolongs as well as adds quality to life.