ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 2 (60 abstracts)
Hypoadrenalism in Advanced HIV
Ian Ross 1 , Robert Millar 2 , Thabiso Mofokeng 3 , Ashley Grossman 4 , Joel Dave 1 , Naomi Levitt 1 , Tahir Pillay 2 , Rajiv Erasmus 5 , Peter Raubenheimer 1 , Collet Dandara 1 & Gudmundur Johannsson 6
1University of Cape Town, Cape Town, South Africa; 2University of Pretoria, Pretoria, South Africa; 3University of Free State, Bloemfontein, South Africa; 4University of Oxford, Oxford, UK; 5University of Stellenbosch, Stellenbosch, South Africa; 6University of Gothenberg, Gothenberg, Sweden.
Background: Large populations of HIV and tuberculosis occur in South Africa and, amongst these patients, Addison’s disease is probably underdiagnosed. Preliminary data in 60 HIV-positive patients with a CD4 count less than 100 cells/mm3 showed that the overall prevalence of hypoadrenalism was 6.7%, with 1 patient having primary hypoadrenalism and 3 patients having central hypoadrenalism. This report describes the prevalence of hypoadrenalism and its associations in a larger cohort.
Methods: Consecutive HIV-positive patients with a CD4 count 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 500 nmol/l, a 250 μg Synacthen test was performed. Patients were excluded if they had received steroids in the three months prior to enrolment. Anti-tuberculous and antifungal therapy were not considered exclusion criteria for enrolment.
Results: A total of 222 patients (112 males and 110 females) were evaluated. The median age and interquartile range at presentation was 36.0 (31.0–41.0) years. The median duration of feeling unwell prior to admission was 14.0 (14.0–30.0) days. A Synacthen test was performed in (n=87, 39%) of the cohort with (n=14: 6%), demonstrating a 30-minute peak cortisol of less than 500 nmol/l or (n=8; 4%) if a cut-point of 430 nmol/l was used. 4 additional patients were diagnosed by basal cortisol alone; median cortisol 308.0 (267.5–330.8) nmol/l and elevated ACTH. The proportion with central hypoadrenalism was (n=12; 4%), compared with primary hypoadrenalism (n=6; 2.7%) and the risk factors for developing these two states included pulmonary tuberculosis (OR 2.20; 95% CI 0.49; 20.39) and weight loss (OR 3.96; 95% CI 0.97;13.76). The number of patients with relative adrenal insufficiency i.e. a cortisol increment, less than 200 nmol/l (n=38) was 17.1%. The median maximal stimulated cortisol response following a Synacthen test was 678.0 (548.0–790.0) nmol/l.
Conclusions: As the proportions of hypoadrenalism are 8.1% and relative adrenal insufficiency (17.1%), the clinical significance needs to be determined.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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