ABSTRACT
Non-HIV AIDS or idiopathic CD4 lymphocytopenia (ICL) is an acquired immunodeficiency syndrome resulting in CD4 lymphopenia without any evidence of HIV infection or any other apparent cause of immunosuppression. A non-diabetic patient presented with adrenal histoplasmosis and UTI leading to adrenal failure. No immediate cause of immunosuppression was found, HIV, HTLV screening were negative. A CD4 count was done and the patient was found to be having non-HIV AIDS (idiopathic CD4 lymphocytopenia). He was treated and discharged. Few months later the patient presented again with adrenal failure & pulmonary tuberculosis. Adrenal FNAC showed persisting adrenal histoplasmosis. CD4 count found to be low again, but this time it was worse than the previous scenario
ABSTRACT
La insuficiencia suprarrenal crónica es una enfermedad que se caracteriza por el déficit de las hormonas de la corteza adrenal. Necesita tratamiento sustitutivo de por vida para lograr suplir ese déficit y así poder desarrollar una vida normal y con calidad. Para el éxito del tratamiento sustitutivo es muy importante conocer sus pautas y variantes, lo que resulta un arma en el trabajo diario de los galenos. Conocer las tendencias actuales resulta algo imprescindible, por lo que el propósito del siguiente trabajo es revisar las diferentes variantes del tratamiento que se pueden usar en este grupo de enfermos(AU)
Chronic adrenal failure is a disease characterized by shortage of adrenal cortex hormones. It requires lifelong replacement treatment to overcome this shortage in order to enjoy quality normal life. For the replacement treatment to be successful, it is very important to learn about its guidelines and variants, which is a useful tool in the daily work of physicians. Knowing the present trends is indispensable; therefore, the objective of this paper was to review the different treatment variants that may be used in this group of patients(AU)
Subject(s)
Humans , Adrenal Insufficiency/drug therapy , Glucocorticoids/therapeutic use , Drug Substitution/methods , Autoimmune Diseases/etiologyABSTRACT
The study of hypothalamic, pituitary adrenal axis function requires complex tests. However, themeasurement of basal morning serum cortisol levels may be a simple measure to evaluate this axis. AIM: To determine if an isolated morning measurement of basal serum cortisol levels in the absence of stress, may predict the indemnity of the hypothalamic, pituitary adrenal axis. MATERIAL AND METHODS: Morning cortisol levels in the basal period and 30 minutes after the injection of 50 ug ACTH were measured in 76 patients with a mean age of 52 years (48 females), operated of a pituitary tumor, without cushing syndrome and not using steroids or oral estrogens. Twenty healthy volunteers with a mean age of 30 years (11 males) were studied as controls. In this last group, the lower limit of normal stimulated cortisol levels was defined as the mean value less two standard deviations and corresponded to 17 ug/dL. RESULTS: Based on stimulated cortisol levels, 15 percent of operated patients had a hypothalamic, pituitary adrenal axis dysfunction. Using cut-off levels of less than 5, 7.5 and 10 ug/dL, basal cortisol levels had a sensitivity for the diagnosis of hypothalamic, pituitaryadrenal axis dysfunction of 64, 81 and 100 percent, respectively. The figures were 100, 95 and 66 percent for specificity respectively, 100, 75 and 34 percent for positive predictive value and 94, 97 and 100 percent for negative predictive value. CONCLUSIONS: A basal morning cortisol value over 10 ug/dL discards the presence of hypothalamic, pituitary adrenal axis dysfunction and a value lower than 5 ug/dL confirmed alteration in all of the cases.