For clinicians, utilizing hyponatremia as a key indicator for targeted routine screening could prove to be a life-saving strategy. Although adrenal insufficiency (AI) is highly prevalent in people living with HIV (PLHIV), standard screening guidelines and specific data for the Indian population remain limited. • Hyponatremia as a Predictor: Analysis identified hyponatremia as a highly significant predictive variable for AI development, explicitly noted in 91% of advanced HIV patients with AI compared to 48% of those without it. • Mortality Indicators: Data confirmed that higher basal cortisol levels, diminished CD4 counts, adverse cortisol/DHEA-S ratios, and concurrent opportunistic infections were strongly associated with increased mortality. Prevalence and clinical associations of adrenal dysfunction in people living with human immunodeficiency virus: A prospective cohort study.