Hypoadrenalism in advanced HIV: a pilot study

Ian Ross; Robert P Millar; Thabiso RP Mofokeng; Fazleh Mahomed; Ashley Grossman; Joel Dave; Naomi Levitt; Tahir Pillay; Rajiv Erasmus; Peter Raubenheimer; Gudmundur Johannsson

doi:10.1530/endoabs.56.GP22

GP22

Prev Next

Section Contents Cite

Endocrine Abstracts (2018) 56 GP22 | DOI: 10.1530/endoabs.56.GP22

ECE2018 Guided Posters Adrenal clinical (10 abstracts)

Hypoadrenalism in advanced HIV: a pilot study

Ian Ross ¹ , Robert P Millar ^2, , Thabiso RP Mofokeng ⁴ , Fazleh Mahomed ⁴ , Ashley Grossman ⁵ , Joel Dave ¹ , Naomi Levitt ¹ , Tahir Pillay ^1, , Rajiv Erasmus ⁸ , Peter Raubenheimer ¹ & Gudmundur Johannsson ⁹

Err

Author affiliations

¹University of Cape Town, Cape Town, South Africa; ²Centre of Neuroendocrinology, University of Pretoria, Pretoria, South Africa; ³Institute of Infectious Diseases and Molecular Medicine, Cape Town, South Africa; ⁴Department of Medicine University of the Free State, Bloemfontein, South Africa; ⁵University of Oxford, Oxford, UK; ⁶Chemical Pathology University of Pretoria, Pretoria, South Africa; ⁷NHLS, Pretoria, South Africa; ⁸University of Stellenbosch, Cape Town, South Africa; ⁹Institute of Medicine Sahlgrenska, Gothenberg, Sweden.

Background: Addison’s disease is probably under-diagnosed in South Africa, given that the prevalence is considerably lower than reported in Western countries (Chabre O 2017); this is important as patients may be dying from a highly treatable condition. In addition, large populations of HIV and tuberculosis infected patients in South Africa may have some symptoms erroneously attributed to these conditions, rather than Addison’s disease. We determined the prevalence and aetiology of Addison’s disease among hospitalised HIV-infected patients.

Methods: HIV-positive patients with a CD4 count of less than 100 cells/mm³ and concurrent opportunistic infection, who were admitted to a medical ward were assessed with simultaneous early morning plasma cortisol and ACTH analysed by immunoassay (Roche Cobas 6000 platform). Where the basal cortisol was less than 550 nmol/l, a 250 μg Synacthen test was performed. Patients were excluded if they had received any steroids in the three months prior to enrolment.

Results: A total of 60 patients (23 males and 37 females) were evaluated in this interim analysis. The age median and interquartile range at presentation was 36.0 (32.0–40.0) years. The median duration of feeling unwell, prior to admission was 26.0 (14.0–60.0) days. Intercurrent pulmonary tuberculosis (TB) was diagnosed in 60% of these patients and 11 (18%) were already on antiretroviral treatment. Despite being severely ill, 37 (61%) had a basal cortisol of less than 550 nmol/l and the basal ACTH was elevated in 12%, whereas in the remainder it was in the reference range. A 250 μg Synacthen test was performed in 21 (35%). Of these four patients had an inadequate cortisol reserve at 30 min (<550 nmo/l), of whom three patients had central hypoadrenalism and one patient had primary hypoadrenalism, suggesting an overall prevalence of hypoadrenalism in this group of 6.7%. The median maximal cortisol following a Synacthen test was 697.0 (558.0–793.0) nmol/l, with at least five additional patients demonstrating an increment of less than 200 nmol/l.

Conclusions: In this severely ill patient group, at least 8% demonstrated relative adrenal insufficiency, which could contribute to the future high mortality Preliminary data indicate a relatively low prevalence of overt hypoadrenalism (6.7%), but since it is a life-threatening illness it warrants screening in the future.