AEGiS-13IAC: Evaluation of Hypothalamic pituitary adrenal axis status in symptomatic HIV positive children.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Evaluation of Hypothalamic pituitary adrenal axis status in symptomatic HIV positive children.

Int Conf AIDS 2000 Jul 9-14; 13:42 (abstract no.. LbFeB7042)

Merchant R, Menon P, Shah N, Sharma A, Oswal J
Bai Jerbai Wadia Hospital for Children, Parel, India. Fax: +91 22 300 10 17.

BACKGROUND: Objective of this study was to evaluate the adrenal cortisol reserves in symptomatic HIV positive children. As the clinical features of HIV wasting syndrome often overlap that of adrenal insufficiency, the Hypothalmic-Pituitary-Adrenal (HPA) axis evaluation serves as a good marker of adrenal insufficiency. In cases of HIV wasting syndrome it is essential to differentiate associated or additional adrenal dysfunction, as this would help in offering appropriate long term replacement therapy with steroids.

METHODS: Of the 280 HIV positive children being followed up at our HIV Pediatric Center, we selected 15 with moderate to severe wasting and subjected them to HPA axis evaluation. Blood was collected for Basal 8am cortisol estimation by the DSL2100 ACTIVE Cortisol Coated-tube Radioimmunoassay kit. A bolus of 250mcg Synacthen (Short acting ACTH) was given intravenously and serum cortisol was estimated at 30 and 60 minutes. Basal level of Sodium, Potassium and Glucose were also estimated simultaneously. Serum ACTH levels were not estimated.

RESULTS: Basal cortisol levels ranged from 9.38 to 37.9 mcg/dl with a Mean of 19.56 ± 7.2 (Normal = 9 to 25 mcg/dl) Post ACTH values of Serum Cortisol at 30 min ranged from 13.86 to 52.35 mcg/dl with a Mean of 31.21 ± 12.72. Post ACTH values of Serum Cortisol at 60 min ranged from 15.13 to 46.9 mcg/dl with a Mean of 32.66 ± 11.19. The mean cortisol evaluation 30 min Post ACTH was 11.65 mcg/dl(p<0.05) and at 60 min was 12.1 mcg/dl(p<0.004). In 3 patients with most severe wasting, basal cortisol levels were above the normal range, however Post ACTH response was normal (Normal response being an elevation in serum Cortisol by 7 mcg/dl above the basal value). In 3 patients who were moderately symptomatic, a blunted response to ACTH was obtained in spite of normal basal cortisol levels. The sodium, Potassium and Glucose levels were within normal range in all cases.

CONCLUSION: Basal Cortisol levels were normal in 80% patients. Patients with severe debilitation had elevated basal levels and adequate adrenal reserve, suggesting dysregulations of cortisol. 20% patients had blunted ACTH response with normal basal levels. Evaluation of HPA axis hence requires not only basal but also post ACTH levels, to confirm adrenal reserves.

Keywords: AEGIS, Corticotropin, Hydrocortisone, Evaluation Studies, Adrenal Gland Hypofunction, Corticotropin-Releasing Hormone, HIV Infections, Pituitary Gland, Neurosecretory Systems, Adrenal Glands, Hypoglycemic Agents, HIV Seropositivity, HIV Wasting Syndrome, Radioimmunoassay, Child, Human, AIDS
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LbFeB7042