Hyperinsulinemic hypoglycemia associated with possible hypopituitarism in a patient with acquired immunodeficiency syndrome.
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.
Kim
J
J
Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Mooradian
A D
AD
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
D013006:Growth Hormone; D006854:Hydrocortisone