Pituitary and adrenal gland dysfunction in HIV-infected patients
- Melissa Weinberg, MD
Melissa Weinberg, MD
- Assistant Clinical Professor of Medicine
- University of California, San Francisco
- Morris Schambelan, MD
Morris Schambelan, MD
- Professor Emeritus of Medicine
- University of California San Francisco
In the early AIDS epidemic, the diverse endocrine manifestations of HIV infection were more often a consequence of opportunistic infections, neoplasms, or concomitant systemic illness. The widespread use of potent antiretroviral therapy (ART) has led to a decline in the incidence of glandular infiltration by opportunistic infections and neoplasms and has generated increased attention toward the metabolic complications of HIV therapy, including insulin resistance, dyslipidemia, and alterations in body fat distribution.
This topic review will address the assessment and management of pituitary and adrenal disorders in HIV-infected patients. Issues related to HIV lipodystrophy including metabolic syndrome, bone and calcium disorders, and thyroid dysfunction in this population are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy" and "Treatment of HIV-associated lipodystrophy" and "Bone and calcium disorders in HIV-infected patients" and "Thyroid gland dysfunction in HIV-infected patients".)
In general, the diagnosis and treatment of a specific endocrinopathy in a patient with HIV infection does not differ from that in an immunocompetent individual. There are, however, some special considerations. HIV infection may cause changes in pituitary and adrenal function that are adaptive and do not require treatment. Furthermore, many of the signs and symptoms of pituitary and adrenal dysfunction are nonspecific and can overlap with other non-endocrine disorders that are common in HIV-infected patients. Finally, many medications that are used to treat HIV infection and its complications can induce endocrine dysfunction (table 1), including affecting pituitary and adrenal hormones.
OPPORTUNISTIC INFECTIONS AND CANCERS
In the era of potent antiretroviral therapy (ART), infections and malignancies (ie, Kaposi sarcoma and lymphoma) in the adrenal and pituitary glands are rare in HIV-infected patients though they may be observed in patients not receiving ART and those with antiretroviral drug-resistant infection (table 2).
Tissue is generally required for a definitive diagnosis. When technically feasible, fine-needle aspiration (FNA) biopsy of the adrenal gland provides a less invasive alternative to open biopsy. Pheochromocytoma must always be excluded before FNA biopsy of the adrenal gland is performed. Standard functional testing should also be performed since clinically significant endocrine dysfunction may accompany glandular infection or infiltration of the pituitary or adrenal glands.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL PRINCIPLES
- OPPORTUNISTIC INFECTIONS AND CANCERS
- PITUITARY GLAND
- Alterations in pituitary function
- The somatotropic axis
- - HIV-associated lipodystrophy
- - AIDS wasting
- Effects of ART on pituitary function
- Clinical manifestations
- Evaluation of pituitary dysfunction
- ADRENAL GLAND
- Alterations in adrenal function
- Dehydroepiandrosterone replacement therapy
- Effects of medications on adrenal function
- - Antiretroviral drugs
- - Protease inhibitors with glucocorticoids
- - Other medications used in HIV-infected patients
- Evaluation and treatment of adrenal dysfunction
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS