Assessing glycaemic control in non-insulin dependent diabetes: acceptability of blood sampling at home.

*Expected maximum >600 nmol/l. deficiency. The high cortisol concentration during his first admission suggested that there was no deficiency in production of glucocorticoids, only in mineralocorticoids, although the suboptimal rise during infusion of tetracosactrin indicated some loss of reserve cortisol. Postmortem studies have shown a high prevalence of adrenal disease in patients with AIDS. In one study of 41 subjects at necropsy 51% had cytomegalovirus adrenalitis. Hyponatraemia was the most common finding (in 75%), although only two subjects had been suspected during life of having adrenal insufficiency.' Stimulation with tetracosactrin may indicate impairment of adrenal function despite normal or high cortisol concentrations measured at random. 1-3 The cause of the adrenal dysfunction in our case is unknown; the dysfunction would probably have been overlooked if reliance had been placed on the raised cortisol concentration. We suggest that in patients with AIDS with lethargy, hypotension, hyponatraemia, or hyperkalaemia, deficiencies of mineralocorticoids and glucocorticoids should be investigated by measurement of aldosterone concentration and plasma renin activity; prolonged stimulation with tetracosactrin (intravenously or intramuscularly); and, perhaps, assay of serum adrenocorticotrophic hormone concentration when the serum cortisol concentration is normal or low. Our findings suggest that some of the morbidity associated with AIDS is a result of mineralocortical deficiency. Adrenal complications caused by HIV are easily treated and should be considered in all patients with infections related to AIDS.