title: Hyperinsulinemic hypoglycemia associated with possible hypopituitarism in a patient with acquired immunodeficiency syndrome.
abstract: OBJECTIVE
  To describe endocrine dysfunctions associated with human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  We present a case report, discuss the laboratory findings, and suggest potential contributing factors in this complex milieu.
  
  
  RESULTS
  A 44-year-old man infected with HIV was admitted with loss of consciousness after a grand mal seizure and was found to have a prolonged course of hypoglycemia in conjunction with increased serum levels of insulin and C peptide. Iatrogenic hypoglycemia was excluded by laboratory evaluations. Hypothalamic-pituitary dysfunction was suspected because the serum growth hormone and cortisol concentrations during hypoglycemia were low. Radiologic evaluation of the brain revealed no structural abnormalities involving the hypothalamic-pituitary area. A normal cortisol response to adrenocorticotropic hormone stimulation (cosyntropin, 250 mg) was documented on two occasions. The cause of the severe hypoglycemic episode and the possible hypothalamic-pituitary-adrenal axis dysfunction in this patient is unknown.
  
  
  CONCLUSIONS
  Despite the complexity of endocrine disorders in HIV-infected patients, the course of the disease in this patient underscores the possibility that some of the endocrinologic changes may be reversible.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: A D
authors.initials: AD
authors.lastname: Mooradian
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006946:Hyperinsulinism / Q000150:complications*; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology*; D007018:Hypopituitarism / Q000150:complications*; D008297:Male
chemical_list: D013006:Growth Hormone; D006854:Hydrocortisone