A patient who is HIV positive may be at increased risk for adrenal insufficiency.
Patient selection: HIV-positive
Risk factors for adrenal insufficiency include:
(1) cytomegalovirus antigenemia
(2) tuberculosis
(3) critical illness
(4) malignant lymphoma involving the adrenal gland
(5) Kaposi's sarcoma
(6) drugs such as ketoconazole, rifampicin, or phenytoin
(7) toxoplasmosis
(8) Histoplasmosis
(9) Cryptococcosis
(10) Pneumocystis jiroveci
(11) AIDS
The adrenal insufficiency may arise from involvement of the pituitary gland and/or involvement of the adrenal gland. If the adrenal gland is involved, then the serum ACTH is elevated. If the pituitary is affected the serum ACTH is low.
Clinical features:
(1) fatigue
(2) weight loss
(3) abdominal pain
(4) vomiting
(5) muscle pain or weakness
(6) joint pain
(7) low grade fever
(8) postural hypotension
(9) skin hyperpigmentation
(10) salt craving
(11) weight loss
Measurement of early morning serum cortisol or cortisol after stimulation shows decreased serum concentrations.
Other laboratory tests may include:
(1) hyponatremia
(2) hyperkalemia (but normokalemia and hypokalemia possible)
(3) eosinophilia > 3%
(4) hypoglycemia
