To the Editor.—The excellent article in the Archives by Aron1 on endocrine complications of acquired immunodeficiency syndrome (AIDS)1 notes "... subnormal cortisol responses to corticotropin observed in 54% of the patients with AIDS...." This statement, which is taken directly from an article by Membreno et al on adrenocortical function in AIDS2 (cited as reference 11 by Aron) suggests a widespread prevalence of limited adrenal reserve in AIDS. However, to arrive at this high figure of 54% subnormal cortisol responses to corticotropin (ACTH) in AIDS, Membreno et al used, as the lower limit of normal for cortisol response to ACTH, a value that was rather unusually defined as only one SD below the mean of their normal subjects. By contrast, Membreno et al state in the same article that mean plasma cortisol responses after ACTH were similar in their patients with AIDS and normal controls, and that 86%
GLASS AR. Endocrine Complications of Acquired Immunodeficiency Syndrome. Arch Intern Med. 1990;150(1):221. doi:10.1001/archinte.1990.00390130177033
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