What is the role of AIDS in the development of chronic Addison disease?

Updated: Mar 11, 2020
  • Author: George T Griffing, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Acquired immunodeficiency syndrome (AIDS) [28, 29, 30]

  • The adrenocortical insufficiency in patients with AIDS tends to occur late and usually in the setting of a low CD4 cell count.

  • It is caused by opportunistic infections such as cytomegalovirus, Mycobacterium avium intracellulare, cryptococci, or Kaposi sarcoma.

  • Adrenocortical hypofunction in patients with HIV may be due to glucocorticoid resistance syndrome. These patients tend to present with features of adrenocortical insufficiency and mucocutaneous hyperpigmentation but also with increased plasma and urinary cortisol levels and a slight elevation in ACTH levels. Hyperpigmentation in patients with HIV is thought to be due to elevated alpha-interferon levels.

  • Another possible cause of adrenocortical insufficiency in patients with AIDS is the use of megestrol acetate (Megace) as an appetite stimulant to stem HIV wasting disease. However, this causes secondary adrenocortical insufficiency and not Addison disease. The glucocorticoid effect of megestrol acetate suppresses pituitary ACTH production and leads to secondary adrenocortical insufficiency.


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