Cortisol resistance in a HIV infected patient
A few endocrine disturbances had been reported in HIV infected patients but cortisol resistance was exceptional.
A 24 years old lady was admitted in the internal medicine unit of the teaching hospital in Cotonou (Bénin) unconscious. Her illness has began since 3 months ago with hyperthermia, diarrhoea, wasting and recurrent convulsive crisis and was unsuccessful treated by traditional healers. At physical examination, there was a severe dehydration, fever (38.7 °C) and arterial hypotension. Research of malaria infestation was negative and macro and microscopic examination of cephalo-rachidian fluid was normal excluding meningo-encephalitis. Other biological examinations showed anything else than a moderate anemia and hypokalemia. A diagnosis of adrenal failure in a HIV infected patient was suspected. Rehydration with electrolyte compensation resulted in the recovery of consciousness. HIV infection was confirmed by a positive HIV serology. Surprisingly, plasma level of cortisol was very high suggesting a resistance to cortisol action. Since common disturbance of adrenal function reported in HIV infected patients was adrenal failure, it seams interesting to report this case, which was likely a case of cortisol resistance in a HIV infected patient. If mechanism of adrenal failure in HIV infected patients is quite clear, cortisol resistance needs to be confirmed by more other observations and its mechanism to be investigated.