Primary adrenocortical insufficiency in patients with AIDS in Wuhan, China: 3 cases report and literature review.

BACKGROUND: Primary adrenal insufficiency (PAI) is a common endocrine complication in AIDS patients, but the diagnosis is often delayed due to the atypical clinic symptoms, which may result in a life-threatening adrenal crisis. RESULT: In this report we present the clinical data of three patients with AIDS and PAI, summarizing the etiology, clinical characteristics, treatment and prognosis. All enrolled three patients were male, aged between 32 and 54 years. Their CD4+ T lymphocyte count (CD4 count) were 58 cells/µL, 378 cells/µL and 35 cells/µL respectively. Two patients had cytomegalovirus (CMV) infection and one had tuberculosis (TB), which were considered to be the main etiologies for PAI. The reported cases exhibited nonspecific clinical symptoms, including fatigue, weight loss, vomiting, diarrhea, anorexia, and fever. All three patients had skin and mucous membrane hyperpigmentation, and two experienced adrenal crisis characterized by intractable hypotension and hyponatremia. Laboratory results revealed low cortisol and higher adrenocorticotropic hormone (ACTH) in serum. All patients responded well to glucocorticoid replacement therapy. By follow-up, their CD4 counts increased steadily. CONCLUSIONS: In patients with AIDS, especially those with opportunistic infection such as CMV infection or TB, PAI should be considered when symptoms of glucocorticoid deficiency are present. Conversely, in AIDS patients diagnosed with PAI, potential underlying infections such as CMV or TB should be actively investigated.