Abstract
Limited cortisol response to ACTH stimulation has been documented in 22 to 48% of patients with paracoccidioidomycosis (PM). Different approaches to interpret the test and inadequate selection of patients preclude an accurate appraisal of the actual incidence of adrenal insufficiency in PM. Rapid cosyntropin (ACTH) stimulation tests were performed in 38 consecutive patients (9 with the localized and 29 with the disseminated form of PM) and 40 normal controls. Subnormal cortisol responses to ACTH (60 minutes post-ACTH values below 455 nmol/l, 95% confidence limits) were found in only 4 patients (14%) with disseminated PM. If a retrospective sample of 6 patients studied previously (in whom tests were indicated due to clinical suspicion of Addison's disease) were included, or if the absolute cortisol increment above baseline was used for interpretation, we would find figures closer to those previously reported (23 and 24%, respectively). These data reflect that non-systematic evaluation or selection of a substandard criterion to interpret the test overestimates the frequency of adrenocortical insufficiency in PM.
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References
Franco M, Mendes RP, Moscardi-Bacchi M, Rezkallah-Iwaso M, Montenegro MR. Paracoccidioidomycosis. Bailliere's Clin Trop Med Cornmun Dis 1989; 4: 185–220.
Restrepo MA. Paracoccidioides Brasiliensis. In: Mandell GL, Gordon Douglas R, Bennett JE, eds. Principles and practice of infectious diseases, 3rd ed. New York: Churchill Livingstone, 1990: 2028–31.
Del Negro G, Wajchenberg BL, Pereira VG, et al. Addison's disease associated with south american blastomycosis. Ann Intern Med 1961; 54: 189–97.
Abad A, Gomez I, Velez P, Restrepo A. Adrenal function in paracoccidioidomycosis a prospective study in patients before and after ketoconazole therapy. Infection 1986; 14: 22–32.
Del Negro G. Localizacao supra-renal da blastomicose sulamericana. [Thesis]. University of Sao Paulo School of Medicine, Sao Paulo, 1961.
Del Negro G, Melo EHL, Rodbard D, Melo MR, Layton J, Wachslicht-Rodbard H. Limited adrenal reserve in paracoccidioidomycosis: cortisol and aldosterone responses to 1–24 ACTH. Clin Endocrinol 1980; 13: 553–9.
Moreira AC, Martinez R, Castro M, Elias LLK. Adrenocortical-lipotropin/adrenocorticotropin levels and adrenocortical tests. Clin Endocrinol 1992; 36: 545–51.
Magarinos TC, Duarte E, Guimaraes J, Moreira LF. Destructive lesion of the adrenal gland in South-Arnerican Blastomycosis (Lutz's Disease). Am J Pathol 1952; 28: 145–55.
Marsiglia I, Pinto J. Adrenal cortical insufficiency associated with paracoccidioidomycosis (South-American Blastomycosis). Report of four patients. J Clin Endocrinol 1966; 26: 1109–15.
Feldman D. Ketoconazole and other imidazole derivates as inhibitors of steroidogenesis. Endocr Rev 1986; 7: 409–20.
May ME, Carey RM. Rapid adrenocorticotropic hormone test in practice: retrospective review. Am J Med 1985; 79: 679–84.
Lewi DS, Kater CE. Adrenocortical insufficiency in patients with acquired immunodeficiency syndrome (AIDS). Rev Ass Med Brasil 1988; 34: 213–8.
Finlay WEY, McKee JI. Serum cortisol levels in severely stressed patients. Lancet 1982; (ii): 1414–5.
Chandraprasert S, Sridama V, Limtongkul S, Vajanamarhutue C. The response of adrenal gland in tuberculosis. J Med Ass Thailand 1984; 67: 224–30.
Kukreja SC, Williams GA. Corticotrophin stimulation test: Inverse correlation between basal serum cortisol and its response to corticotrophin. Acta Endocrinol 1981; 97: 522–4.
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Colombo, A.L., Faiçal, S. & Kater, C.E. Systematic evaluation of the adrenocortical function in patients with paracoccidioidomycosis. Mycopathologia 127, 89–93 (1994). https://doi.org/10.1007/BF01103064
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DOI: https://doi.org/10.1007/BF01103064