Eledrisi M S, Verghese A C
Department of Internal Medicine, University of Texas Medical Branch, Galveston 77555, USA.
Am J Med Sci. 2001 Feb;321(2):137-44. doi: 10.1097/00000441-200102000-00005.
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.
肾上腺功能不全是已知的HIV感染并发症，尽管其患病率和严重程度的估计各不相同。肾上腺功能不全是HIV感染者中发生的最严重的内分泌并发症。获得性免疫缺陷综合征（AIDS）患者被认为有原发性或继发性肾上腺功能不全的高风险。我们描述了3例AIDS患者，他们具有提示肾上腺功能不全的临床特征，但促肾上腺皮质激素（ACTH）刺激试验结果正常。重复检测确诊了1例患者，而对另1例患者进行的过夜甲吡酮试验进一步检测显示有继发性肾上腺功能不全的证据。后续糖皮质激素治疗后临床持续改善明显。ACTH刺激试验的正常反应可能会产生危险的误导。ACTH刺激试验筛查正常但怀疑有肾上腺功能不全的AIDS患者应接受继发性肾上腺疾病的进一步检测。
