Assessment of adrenal function by measurement of salivary steroids in response to corticotrophin in patients infected with human immunodeficiency virus

Abstract

Objective: Adrenal insufficiency has been reported among critically ill HIV-infected patients. This is the first study that attempts to detect subclinical hypoadrenal states in non-critical HIV patients through salivary steroids in response to intramuscular low-dose ACTH injection. Patients and methods: We studied 21 ambulatory adult HIV-infected patients without specific clinical signs or symptoms of adrenal insufficiency. Normal salivary flow-rate and salivary -amylase activity confirmed adequate salivary gland function. Salivary cortisol (SAF) and salivary aldosterone (SAL) were obtained at baseline and 30min after the injection of 25g of ACTH in the deltoid muscle (LDTs). Assessment of salivary steroids after stimulation with 250g of intramuscular ACTH (HDTs) was performed on those who hyporesponded to LDTs. Basal blood samples were drawn for steroids, renin and ACTH measurements. Results: At baseline SAF and SAL correlated significantly (p = 0.0001) with basal serum cortisol and aldosterone (r = 0.70 and 0.91, respectively). Plasma ACTH and renin concentrations were within the normal range in all patients. Eight of the twenty-one HIV+ patients were LDTs hyporesponders in either SAF (n:1) or SAL (n:7). LDTs repeated in six cases after a year reconfirmed the impairment of aldosterone secretion. LDTs hyporesponders had normal steroid responses to HDTs. Conclusions: LDTs is a simple, safe, well-accepted and non-invasive approach to assess adrenal function in HIV-infected ambulatory patients. It revealed subnormal cortisol (5%) and aldosterone responses (33%) when HDTs results were normal.