The causes and management of endocrine disorders associated with human immunodeficiency virus (
HIV) infection are reviewed. Endocrine disorders observed in HIV-positive patients include adrenal abnormalities,
hyporeninemic hypoaldosteronism,
pituitary insufficiency, pancreatic abnormalities, thyroid and
parathyroid disorders, and testicular abnormalities. Opportunistic pathogens implicated in these disorders include cytomegalovirus, Cryptococcus, Toxoplasma, mycobacteria, Candida, and Aspergillus. Neoplasma such as
Kaposi's sarcoma and
lymphoma can also cause endocrine abnormalities. Several drugs used in patients with the
acquired immunodeficiency syndrome (
AIDS) are associated with the development of endocrine disorders. These drugs include
ketoconazole,
itraconazole,
rifampin,
vidarabine,
pentamidine,
trimethoprim-sulfamethoxazole,
didanosine, and
ganciclovir. Severe patient debilitation can contribute to the development of endocrine abnormalities. Monitoring of adrenal gland function may be prudent in HIV-infected patients who have nonspecific symptoms of
adrenal insufficiency. If
adrenal insufficiency is diagnosed, replacement
therapy with oral
hydrocortisone is required. Administration of
fludrocortisone can rapidly alleviate the signs and symptoms of
hyporeninemic hypoaldosteronism. Fluid restriction is the first step in managing the pituitary abnormality known as the syndrome of inappropriate secretion of
antidiuretic hormone.
Drug-induced endocrine abnormalities often resolve after withdrawal of the offending agent. Endocrine complications in HIV-infected patients may be caused by
infection,
malignancy, or drugs. Adjusting or instituting
drug therapy may be necessary to control symptomatic endocrine abnormalities.