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Pituitary and adrenal gland dysfunction in HIV-infected patients

Melissa Weinberg, MD
Morris Schambelan, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Howard Libman, MD, FACP


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 the HIV-infected patient".)


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.


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.

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Literature review current through: Nov 2017. | This topic last updated: Oct 10, 2017.
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