• 1.

    Franco M, Mendes RP, Moscardi-Bacchi M, Rezkallah-Iwaso M, Montenegro MR, 1989. Paracoccidioidomycosis. Bailliere's Clin Trop Med Commun Dis 4: 185220.

    • Search Google Scholar
    • Export Citation
  • 2.

    Restrepo A, Tobón A, 2005. Paracoccidioides brasiliensis. Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Sixth edition. New York: Churchill Livingstone, 30623068.

    • Search Google Scholar
    • Export Citation
  • 3.

    Restrepo A, Tobón A, Agudelo C, 2008. Paracoccidioidomycosis. Hospenthal DR, Rinaldi MG, eds. Diagnosis and Treatment of Human Mycoses. Totowa, NJ: Humana Press, 331342.

    • Search Google Scholar
    • Export Citation
  • 4.

    Del Negro G, Wajchenberg BL, Pereira VG, Schneider J, Ulhoa-Cintra AB, Assis LM, Sampaio AS, 1961. Addison's disease associated with South American blastomycosis. Ann Intern Med 54: 189197.

    • Search Google Scholar
    • Export Citation
  • 5.

    Oñate J, Tobón A, Restrepo A, 2002. Insuficiencia suprarenal secundaria a paracoccidioidomicosis. Biomedica (Bogota) 22: 280286.

  • 6.

    Tendrich M, Wanke B, Del Negro G, Wajchenberg B, 1993. Adrenocortical involvement in paracoccidioidomycosis. Franco M, Da Silva C, Restrepo A, Del Negro G, eds. Paracoccioidomycosis. Boca Raton, FL: CRC Boca Raton, 303310.

    • Search Google Scholar
    • Export Citation
  • 7.

    Salfelder K, Doehnert G, Doehnert HR, 1969. Paracoccidioidomycosis; anatomic study with complete autopsies. Virchows Arch A Pathol Pathol Anat 348: 5176.

    • Search Google Scholar
    • Export Citation
  • 8.

    Faiçal S, Borri ML, Hauache OM, Ajzen S, 1996. Addison's disease caused by Paracoccidioides brasiliensis: diagnosis by needle aspiration biopsy of the adrenal gland. AJR Am J Roentgenol 166: 461462.

    • Search Google Scholar
    • Export Citation
  • 9.

    Gomez BL, Figueroa JI, Hamilton AJ, Diez J, Rojas M, Tobon AM, Hay RJ, Restrepo A, 1998. Antigenemia in patients with paracoccidioidomycosis: detection of the 87-kilodalton determinant during and after antifungal therapy. J Clin Microbiol 36: 33093316.

    • Search Google Scholar
    • Export Citation
  • 10.

    Colombo A, Faiçal S, Kater C, 1994. Systematic evaluation of the adrenocortical function in patients with paracoccidioidomycosis. Mycopathologia 127: 8993.

    • Search Google Scholar
    • Export Citation
  • 11.

    Oelkers W, 1996. Adrenal insufficiency. N Engl J Med 335: 12061212.

  • 12.

    Stewart PM, 2007. The adrenal cortex. Williams RH, Foster DW, Kronenberg HM, eds. Williams Textbook of Endocrinology. 11th edition. Philadelphia: W.B. Saunders, 445504.

    • Search Google Scholar
    • Export Citation
  • 13.

    Winqvist O, Rorsman F, Kämpe O, 2000. Autoimmune adrenal insufficiency: recognition and management. BioDrugs 13: 107114.

  • 14.

    Lacaz CS, Porto E, Martins JE, Heins-Vaccari E, de Melo NT, 2002. Paracoccidioidomicose. Lacaz C, Porto E, Martins JE, eds. Tratado de Micologia Médica Lacaz. Ninth edition. Sao Paulo, Brazil: Sarvier, 639729.

    • Search Google Scholar
    • Export Citation
  • 15.

    Restrepo-Moreno A, 2003. Paracoccidioidomycosis. Dismukes WE, Pappas PG, Sobel JD, eds. Clinical Mycology. New York: Oxford University Press, 328345.

    • Search Google Scholar
    • Export Citation
  • 16.

    Camargo ZP, 2008. Serology of paracoccidioidomycosis. Mycopathologia 165: 289302.

  • 17.

    Agudelo CA, Muñoz C, Ramírez A, Gutierrez J, Vélez S, Pérez JC, Vélez A, Tobón AM, Restrepo A, 2009. Identification of Paracoccidioides brasiliensis in adrenal glands biopsies of two patients with paracoccioidomycosis and adrenal insufficiency. Rev Inst Med Trop Sao Paulo 51: 4548.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 

 

 

 

 

Adrenal Function Status in Patients with Paracoccidioidomycosis after Prolonged Post-Therapy Follow-Up

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  • Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia; Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia; Laboratorio Clínico Congregación Mariana, Medellín, Colombia

This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy.

Author Notes

*Address correspondence to Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A, No. 78B–141, Medellín, Colombia. E-mail: arestrepo@cib.org.co

Financial support: This study was supported by Corporación para Investigaciones Biológicas, Centro de Investigación para el Desarrollo y la Innovación from the Universidad Pontificia Bolivariana and Hospital Pablo Tobón Uribe.

Authors' addresses: Angela M. Tobón, Carlos A. Agudelo, and Angela Restrepo, Corporación para Investigaciones Biológicas, Medellín, Colombia, E-mails: atobon@cib.org.co, carlosagudelo@yahoo.com, and arestrepo@cib.org.co. Carlos A. Restrepo and Carlos A. Villa, Universidad Pontificia Bolivariana, School of Health Sciences, Medellín, Colombia, E-mails: restrepocastro@gmail.com and andres801@une.net.co. William Quiceno, Hospital Pablo Tobón Uribe, Medellín, Colombia, E-mail: williamdejquiceno@hotmail.com. Santiago Estrada, Laboratorio Clínico Congregación Mariana, Medellín, Colombia, E-mail: sestrada@congregacionmariana.org.co.

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