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Adrenocortical dysfunction in paracoccidioidomycosis: comparison between plasma β‐lipotrophin/adrenocorticotrophin levels and adrenocortical tests
Author(s) -
Moreira Ayrton C.,
Martinez Roberto,
Castro Margaret,
Ellas Luclla L. K.
Publication year - 1992
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1992.tb02263.x
Subject(s) - medicine , endocrinology , aldosterone , paracoccidioidomycosis , corticosterone , adrenocorticotropic hormone , plasma renin activity , glucocorticoid , basal (medicine) , hydroxycorticosteroids , adrenal cortex , mineralocorticoid , renin–angiotensin system , hormone , immunology , blood pressure , urine , insulin
OBJECTIVE Paracoccidioidomycosis is an important cause of Addlson's disease in South America. We have carried out an extensive and prospective study on paracoccidioidomycosis comparing glucocorticoid, mineralo‐corticoid and androgen function with adrenal regulators, ACTH/β‐LPH and plasma renin activity (PRA). PATIENTS AND METHODS Forty‐seven male patients with active paracoccidioidomycosis were studied consecutively together with 20 healthy controls. On day 1, plasma aldosterone and PRA levels were measured in blood samples obtained from patients in the supine and erect position. On day 2 at 0900 h, baseline plasma samples were taken for ACTH, β‐lipotrophin (β‐LPH), cortisol, corticosterone, aldosterone, androstenedlone (Δ 4 ‐A) and dehydroeplandrosterone sulphate (DHEA‐S). ACTH 1–24 (250 μg) was given i. v. and blood samples for these steroid assays were taken at 1 and 2 hours. RESULTS Five patients (10%) had Addison's disease with high basal plasma ACTH and β‐LPH, and low cortisol levels after the ACTH test. In the remaining 42 patients, baseline ACTH and β‐LPH levels and plasma cortisol after ACTH were within the normal range. A high percentage of patients presented with reduced corticosterone (21% of patients) and aldosterone (23%) secretion and increased PRA (31%). Plasma Δ 4 ‐A (19%) and DHEA‐S (50%) levels were also reduced. CONCLUSIONS The frequency of Addison's disease among our patients with paracoccidioidomycosis was 10%. In addition, a subset of patients presented with adrenal dysfunction detected by mineralocorticoid or androgen tests. In parallel to pathological lesions a functional adaptation may occur during adrenal involvement in paracoccidioidomycosis.