• David B Meya, Elly Katabira, Marcel Otim, Allan Ronald, Robert Colebunders, Denise Njama, Harriet Mayanja-Kizza, Christopher C Whalen, and Merle Sande.
• Infectious Disease Institute, Makerere University, Faculty of Medicine, Kampala, Uganda. david.meya@gmail.com
• Afr Health Sci. 2007 Jun 1; 7 (2): 101107101-7.

BackgroundFunctional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness.MethodsAfter screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with FAI.ResultsFunctional adrenal insufficiency, defined in this study as morning total serum cortisol level of 3%) occurred in 52% (11 of 21) patients with FAI compared to 24% (22 of 92) patients with normal adrenal function (p= 0.01). Factors predicting FAI on multivariate analysis were use of rifampicin and eosinophilia. The mortality rate among patients with FAI (19%) was not significantly different when compared to that among patients with a normal cortisol response (33%) (p=0.221). Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study.ConclusionThe diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies to determine benefits of corticosteroids in critically ill HIV patients are needed in this setting.

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