Lewi D S, Kater C E, Moreira A C
Disciplina de Doenças Infecciosas, Escola Paulista de Medicina, São Paulo.
Rev Assoc Med Bras (1992). 1995 Mar-Apr;41(2):109-18.
Ten-20% of patients with AIDS may present clinical evidence of primary or secondary adrenal insufficiency. PURPOSE--To evaluate the hypothalamic-pituitary-adrenocortical axis (HPAA) with CRH in patients with AIDS. METHODS--We studied 20 patients with AIDS and 17 normal subjects (NS) with exogenous ACTH (cosyntropin, 250 micrograms IV bolus) followed one week later by ovine corticotropin releasing hormone (oCRH 1 microgram/kg BW IV bolus). Basal and 60' cortisol (micrograms/dL) were determined in the former whereas ACTH (pg/mL) and cortisol were measured every 15-30' for 2 hours in the latter. RESULTS--Basal and peak values (mean +/- SD) of ACTH and cortisol for both tests were: cosyntropin test (AIDS x NS): basal cortisol 22.5 +/- 7.1 x 10.6 +/- 3.6 (p < 0.01), peak 36.0 +/- 12.8 x 28.3 +/- 7.6 (p < 0.05); oCRH test: basal ACTH 42.2 +/- 33.5 x 28.9 +/- 12.7 (NS), peak 104.7 +/- 62.2 x 59.3 +/- 17.6 (p < 0.05); basal cortisol 19.7 +/- 9.0 x 10.1 +/- 3.4 (p < 0.01), peak 27.5 +/- 8.9 x 18.3 +/- 5.1 (p < 0.05). CONCLUSION--AIDS patients had elevated basal and CRH stimulated ACTH levels and an intact glucocorticoid pathway with elevated basal and peak cortisol levels to both stimulation tests. This situation is probably due to the stressful disease condition, where lymphokines may play a role activating the hypothalamic-pituitary axis.
10%至20%的艾滋病患者可能会出现原发性或继发性肾上腺功能不全的临床证据。目的——评估艾滋病患者下丘脑-垂体-肾上腺皮质轴（HPAA）对促肾上腺皮质激素释放激素（CRH）的反应。方法——我们研究了20例艾滋病患者和17名正常受试者（NS），先给予外源性促肾上腺皮质激素（合成促肾上腺皮质激素，静脉推注250微克），一周后给予羊促肾上腺皮质激素释放激素（oCRH，静脉推注1微克/千克体重）。前者测定基础及60分钟时的皮质醇（微克/分升），后者在2小时内每隔15至30分钟测定促肾上腺皮质激素（皮克/毫升）和皮质醇。结果——两项试验中促肾上腺皮质激素和皮质醇的基础值及峰值（均值±标准差）为：合成促肾上腺皮质激素试验（艾滋病患者×正常受试者）：基础皮质醇22.5±7.1×10.6±3.6（p<0.01），峰值36.0±12.8×28.3±7.6（p<0.05）；oCRH试验：基础促肾上腺皮质激素42.2±33.5×28.9±12.7（正常受试者），峰值104.7±62.2×59.3±17.6（p<0.05）；基础皮质醇19.7±9.0×10.1±3.4（p<0.01），峰值27.5±8.9×18.3±5.1（p<0.05）。结论——艾滋病患者基础及CRH刺激后的促肾上腺皮质激素水平升高，糖皮质激素途径完整，基础及峰值皮质醇水平在两种刺激试验中均升高。这种情况可能是由于疾病的应激状态，其中淋巴细胞因子可能在激活下丘脑-垂体轴中发挥作用。
