Berg H K, Sestoft L, Laulund S, Visfeldt J, Faber V
Rigshospitalet, København, epidemiafdelingen, og Københavns Universitet, Patologisk Institut.
Ugeskr Laeger. 1991 Jul 8;153(28):2009-12.
Adrenal function was estimated by synthetic ACTH test in 18 men with AIDS (or AIDS-related complex) and compared with that of 10 HIV positive but otherwise healthy men. According to this test none fulfilled the criteria for adrenal insufficiency defined as plasma cortisol concentration less than 500 nmol/l 30 minutes after ACTH stimulation. Seven of eighteen AIDS patients had baseline cortisol concentrations above 0.5 mumol/l compared to none in the HIV-positive group. Three of eighteen AIDS patients had a limited response to synthetic ACTH injection compared to none in the HIV-positive group. Two of these three AIDS patients had lowered serum Na+ concentration; they survived for two and three weeks, respectively. Otherwise the basal cortisol level and response to synthetic ACTH was uncorrelated with survival time, other signs of adrenal insufficiency, treatment with ketokonazole, CMV-infection, T-helper cell count or Th/Ts-ratio. The pituitary-adrenal axis was estimated by measuring the diurnal rhythm of serum ACTH and cortisol in eight patients and was found intact and normal in all of them. Thus, absolute adrenal insufficiency is uncommon in AIDS-patients. Relative adrenal insufficiency may occur in severely ill preterminal patients as a result of primary target organ failure, but the pituitary-adrenal axis generally appears to be undisturbed.
通过合成促肾上腺皮质激素（ACTH）试验评估了18名艾滋病（或艾滋病相关综合征）男性患者的肾上腺功能，并与10名HIV阳性但其他方面健康的男性进行了比较。根据该试验，没有人符合ACTH刺激后30分钟血浆皮质醇浓度低于500 nmol/l所定义的肾上腺功能不全标准。18名艾滋病患者中有7人的基线皮质醇浓度高于0.5 μmol/l，而HIV阳性组中无人如此。18名艾滋病患者中有3人对合成ACTH注射的反应有限，而HIV阳性组中无人如此。这3名艾滋病患者中有2人的血清钠浓度降低；他们分别存活了两周和三周。此外，基础皮质醇水平和对合成ACTH的反应与生存时间、肾上腺功能不全的其他体征、酮康唑治疗、巨细胞病毒感染、辅助性T细胞计数或Th/Ts比值无关。通过测量8名患者血清ACTH和皮质醇的昼夜节律评估了垂体-肾上腺轴，发现所有患者的该轴均完整且正常。因此，绝对肾上腺功能不全在艾滋病患者中并不常见。相对肾上腺功能不全可能在严重疾病的终末期前患者中由于原发性靶器官衰竭而发生，但垂体-肾上腺轴通常似乎未受干扰。
