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CC BY-NC-ND 4.0 · J Lab Physicians 2021; 13(01): 084-090
DOI: 10.1055/s-0041-1723055
Review Article

HIV and the Pituitary Gland: Clinical and Biochemical Presentations

Joyce Youssef
1   Medical School, The University of Buckingham, Buckingham, United Kingdom
,
Rohan Sadera
1   Medical School, The University of Buckingham, Buckingham, United Kingdom
,
Dushyant Mital
2   Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, United Kingdom
,
Mohamed H. Ahmed
3   Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom
› Institutsangaben Funding None.
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Abstract

Human immunodeficiency virus (HIV) can have profound impact on the function of the pituitary gland. We have performed an electronic literature search using the following database: PubMed, Medline, Scopus, and Google Scholar. These databases were searched using the keywords HIV, pituitary glands, cancer, pituitary apoplexy, and infertility. HIV can cause hypopituitarism and also can lead to diabetes insipidus. The impact can be slow and insidious, and diagnosis depends on high index of clinical suspicion. The effect on anterior pituitary gland can be associated with growth hormone deficiency, hypothyroidism, adrenal insufficiency, premature menopause, erectile dysfunction, and infertility. HIV can cause pituitary apoplexy, and this should be treated as an endocrine emergency. Importantly, HIV can be associated with pituitary lymphoma and pituitary cancer. Therefore, joined management between HIV physicians, clinical biochemists and endocrinologists may help in establishing pituitary dysfunction.

Keywords

HIV - pituitary gland - apoplexy - diabetes insipidus


Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 World Health Organization. n.d. Data and Statistics. Available at: https://www.who.int/hiv/data/en/. Accessed April 25, 2020
  • 2 Cks.nice.org.uk. 2018. HIV Infection and AIDS—NICE CKS. Available at: https://cks.nice.org.uk/hiv-infection-and-aids#!diagnosisAdditional:3. Accessed April 25, 2020
  • 3 Arts E, Hazuda D. 2012. HIV-1 antiretroviral drug therapy. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312400/#. Accessed April 25, 2020
  • 4 Filardi PP, Paolillo S, Marciano C. et al. Cardiovascular effects of antiretroviral drugs: clinical review. Cardiovasc Hematol Disord Drug Targets 2008; 8 (04) 238-244
    CrossrefPubMedGoogle Scholar
  • 5 Tavares Bello C, Sousa Santos F, Sequeira Duarte J, Vasconcelos C. Diabetes insipidus and hypopituitarism in HIV: an unexpected cause. Endocrinol Diabetes Metab Case Rep 2017; 2017: 17-0024
    CrossrefPubMedGoogle Scholar
  • 6 Sayed S, Fahmy M, Schwartz J. 2019. Physiology, pituitary gland. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK459247/. Accessed April 24, 2020
  • 7 Amar AP, Weiss MH. Pituitary anatomy and physiology. Neurosurg Clin N Am 2003; 14 (01) 11-23, v
    CrossrefPubMedGoogle Scholar
  • 8 Téblick A, Langouche L, Van den Berghe G. Anterior pituitary function in critical illness. Endocr Connect 2019; 8 (08) R131-R143
    CrossrefPubMedGoogle Scholar
  • 9 Harbeck B, Klose S, Buchfelder M, Brabant G, Lehnert H. Hypopituitarism in a HIV affected patient. Exp Clin Endocrinol Diabetes 2011; 119 (10) 633-635
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Hamdeh S, Abbas A, Fraker J, Lambrecht JE. Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient. Am J Emerg Med 2015; 33 (12) 1848.e1-1848.e2
    CrossrefPubMedGoogle Scholar
  • 11 Zirilli L, Orlando G, Diazzi C. et al. Hypopituitarism and HIV-infection: a new comorbidity in the HAART era?. J Endocrinol Invest 2008; 31 (Suppl. 09) 33-38
    PubMedGoogle Scholar
  • 12 Membreno L, Irony I, Dere W, Klein R, Biglieri EG, Cobb E. Adrenocortical function in acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1987; 65 (03) 482-487
    CrossrefPubMedGoogle Scholar
  • 13 Beltran S, Lescure FX, Desailloud R. et al; Thyroid and VIH Group. Increased prevalence of hypothyroidism among human immunodeficiency virus-infected patients: a need for screening. Clin Infect Dis 2003; 37 (04) 579-583
    CrossrefPubMedGoogle Scholar
  • 14 Rietschel P, Hadigan C, Corcoran C. et al. Assessment of growth hormone dynamics in human immunodeficiency virus-related lipodystrophy. J Clin Endocrinol Metab 2001; 86 (02) 504-510
    PubMedGoogle Scholar
  • 15 Rochira V, Guaraldi G. Growth hormone deficiency and human immunodeficiency virus. Best Pract Res Clin Endocrinol Metab 2017; 31 (01) 91-111
    CrossrefPubMedGoogle Scholar
  • 16 Koutkia P, Meininger G, Canavan B, Breu J, Grinspoon S. Metabolic regulation of growth hormone by free fatty acids, somatostatin, and ghrelin in HIV-lipodystrophy. Am J Physiol Endocrinol Metab 2004; 286 (02) E296-E303
    CrossrefPubMedGoogle Scholar
  • 17 Myhre JA, Chadwick EG, Yogev R. Failure to thrive in HIV-infected children: incidence, prevalence, and clinical correlates. Pediatr AIDS HIV Infect 1996; 7 (02) 83-90
    PubMedGoogle Scholar
  • 18 Viganò A, Mora S, Brambilla P. et al. Impaired growth hormone secretion correlates with visceral adiposity in highly active antiretroviral treated HIV-infected adolescents. AIDS 2003; 17 (10) 1435-1441
    CrossrefPubMedGoogle Scholar
  • 19 Jain S, Desai N, Bhangoo A. Pathophysiology of GHRH-growth hormone-IGF1 axis in HIV/AIDS. Rev Endocr Metab Disord 2013; 14 (02) 113-118
    CrossrefPubMedGoogle Scholar
  • 20 Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep 2013; 10 (03) 199-206
    CrossrefPubMedGoogle Scholar
  • 21 Graef AS, Gonzalez SS, Baca VR. et al. High serum prolactin levels in asymptomatic HIV-infected patients and in patients with acquired immunodeficiency syndrome. Clin Immunol Immunopathol 1994; 72 (03) 390-393
    CrossrefPubMedGoogle Scholar
  • 22 Mira JA, Lozano F, Santos J. et al; Grupo Andaluz para el Estudio de las Enfermedades Infecciosas. Gynaecomastia in HIV-infected men on highly active antiretroviral therapy: association with efavirenz and didanosine treatment. Antivir Ther 2004; 9 (04) 511-517
    CrossrefPubMedGoogle Scholar
  • 23 Wilson LD, Truong MP, Barber AR, Aoki TT. Anterior pituitary and pituitary-dependent target organ function in men infected with the human immunodeficiency virus. Metabolism 1996; 45 (06) 738-746
    CrossrefPubMedGoogle Scholar
  • 24 Thongam S, Keithelakpam S, Singh TY, Singh RL, Singh AM, Ranabir S. Thyroid dysfunction in human immunodeficiency virus-infected children and its correlation with CD4(+) T lymphocyte count. Indian J Endocrinol Metab 2015; 19 (02) 272-276
    CrossrefPubMedGoogle Scholar
  • 25 Madge S, Smith CJ, Lampe FC. et al. No association between HIV disease and its treatment and thyroid function. HIV Med 2007; 8 (01) 22-27
    CrossrefPubMedGoogle Scholar
  • 26 Norbiato G, Galli M, Righini V, Moroni M. The syndrome of acquired glucocorticoid resistance in HIV infection. Baillieres Clin Endocrinol Metab 1994; 8 (04) 777-787
    CrossrefPubMedGoogle Scholar
  • 27 Findling JW, Buggy BP, Gilson IH, Brummitt CF, Bernstein BM, Raff H. Longitudinal evaluation of adrenocortical function in patients infected with the human immunodeficiency virus. J Clin Endocrinol Metab 1994; 79 (04) 1091-1096
    PubMedGoogle Scholar
  • 28 Bajaj S, Pathak Y, Varma S, Verma S. Metabolic status and hypogonadism in human immunodeficiency virus-infected males. Indian J Endocrinol Metab 2017; 21 (05) 684-687
    CrossrefPubMedGoogle Scholar
  • 29 Sayed S, Fahmy M, Schwartz J. 2019. Physiology, pituitary gland. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459247/#_ncbi_dlg_citbx_NBK459247. Accessed April 19, 2020
  • 30 Shu Z, Tian Z, Chen J. et al. HIV/AIDS-related hyponatremia: an old but still serious problem. Ren Fail 2018; 40 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 31 Braconnier P, Delforge M, Garjau M, Wissing KM, De Wit S. Hyponatremia is a marker of disease severity in HIV-infected patients: a retrospective cohort study. BMC Infect Dis 2017; 17 (01) 98
    CrossrefPubMedGoogle Scholar
  • 32 Langford D, Baron D, Joy J. Del Valle L, Shack J. Contributions of HIV infection in the hypothalamus and substance abuse/use to HPT dysregulation. Psychoneuroendocrinology 2011; 36 (05) 710-719
    CrossrefPubMedGoogle Scholar
  • 33 Purba JS, Hofman MA, Portegies P, Troost D, Swaab DF. Decreased number of oxytocin neurons in the paraventricular nucleus of the human hypothalamus in AIDS. Brain 1993; 116 (Pt 4) 795-809
    CrossrefPubMedGoogle Scholar
  • 34 Fekete EM, Antoni MH, Lopez C. et al. Stress buffering effects of oxytocin on HIV status in low-income ethnic minority women. Psychoneuroendocrinology 2011; 36 (06) 881-890
    CrossrefPubMedGoogle Scholar
  • 35 Lee HJ, Macbeth AH, Pagani JH. Young WS III. Oxytocin: the great facilitator of life. Prog Neurobiol 2009; 88 (02) 127-151
    PubMedGoogle Scholar
  • 36 Bispo S, Chikhungu L, Rollins N, Siegfried N, Newell ML. Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20 (01) 21251
    CrossrefPubMedGoogle Scholar
  • 37 2011. Caesarean section clinical guidance. NICE, p.14. Available at: https://www.nice.org.uk/guidance/cg132/resources/caesarean-section-pdf-35109507009733. Accessed April 20, 2020
  • 38 Ranabir S, Baruah MP. Pituitary apoplexy. Indian J Endocrinol Metab 2011; 15 (suppl 3) S188-S196
    CrossrefPubMedGoogle Scholar
  • 39 Wong N, Levy M, Stephenson I. Hypogonadism in the HIV-Infected Man. Curr Treat Options Infect Dis 2017; 9 (01) 104-116
    CrossrefPubMedGoogle Scholar
  • 40 Quintero S Wolfe, Hood B, Barker J, Benveniste RJ. Primary central nervous system lymphoma mimicking pituitary apoplexy: case report. Pituitary 2009; 12 (01) 76-79
    CrossrefPubMedGoogle Scholar
  • 41 Rigolosi RS, Schwartz E, Glick SM. Occurrence of growth-hormone deficiency in acromegaly as a result of pituitary apoplexy. N Engl J Med 1968; 279 (07) 362-364
    CrossrefPubMedGoogle Scholar
  • 42 Sano T, Kovacs K, Scheithauer BW, Rosenblum MK, Petito CK, Greco CM. Pituitary pathology in acquired immunodeficiency syndrome. Arch Pathol Lab Med 1989; 113 (09) 1066-1070
    PubMedGoogle Scholar
  • 43 Rajasekaran S, Vanderpump M, Baldeweg S. et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf) 2011; 74 (01) 9-20
    CrossrefPubMedGoogle Scholar
  • 44 Baldeweg SE, Vanderpump M, Drake W. et al; Society for Endocrinology Clinical Committee. Society for Endocrinology Endocrine Emergency Guidance: Emergency management of pituitary apoplexy in adult patients. Endocr Connect 2016; 5 (05) G12-G15
    CrossrefPubMedGoogle Scholar
  • 45 Rubinstein PG, Aboulafia DM, Zloza A. Malignancies in HIV/AIDS: from epidemiology to therapeutic challenges. AIDS 2014; 28 (04) 453-465
    CrossrefPubMedGoogle Scholar
  • 46 Kozáková D, Macháleková K, Brtko P, Szépe P, Vanuga P, Pura M. Primary B-cell pituitary lymphoma of the Burkitt type: case report of the rare clinic entity with typical clinical presentation. Cas Lek Cesk 2008; 147 (11) 569-573
    PubMedGoogle Scholar
  • 47 Sierra del Rio M, Rousseau A, Soussain C, Ricard D, Hoang-Xuan K. Primary CNS lymphoma in immunocompetent patients. Oncologist 2009; 14 (05) 526-539
    CrossrefPubMedGoogle Scholar
  • 48 Rainsbury P, Mitchell-Innes A, Clifton Nj, Khalil H. Primary lymphoma of the pituitary gland: an unusual cause of hemianopia in an immunocompetent patient. JRSM Short Rep 2012; 3 (08) 55
    CrossrefPubMedGoogle Scholar
  • 49 Fadoukhair Z, Amzerin M, Ismaili N. et al. Symptomatic hypopituitarism revealing primary suprasellar lymphoma. BMC Endocr Disord 2010; 10: 19
    CrossrefPubMedGoogle Scholar
  • 50 Huang YY, Lin SF, Dunn P, Wai YY, Hsueh C, Tsai JS. Primary pituitary lymphoma presenting as hypophysitis. Endocr J 2005; 52 (05) 543-549
    CrossrefPubMedGoogle Scholar
  • 51 Chaudhry NS, Ahmad FU, Blieden C, Benveniste RJ. Brainstem anaplastic glioma in patients with AIDS: a case report and review of the literature. BMJ Case Rep 2013; 2013: bcr2012008384
    CrossrefPubMedGoogle Scholar
  • 52 Choy W, Lagman C, Lee SJ, Bui TT, Safaee M, Yang I. Impact of human immunodeficiency virus in the pathogenesis and outcome of patients with glioblastoma multiforme. Brain Tumor Res Treat 2016; 4 (02) 77-86
    CrossrefPubMedGoogle Scholar
  • 53 Anvari K, Samini F, Faraji M, Khooei A, Ghiasi T, Dehghan P. Pituitary glioblastoma: a case report. Iran J Cancer Prev 2015; 8 (04) e3436
    CrossrefPubMedGoogle Scholar
  • 54 Hall JR, Short SC. Management of glioblastoma multiforme in HIV patients: a case series and review of published studies. Clin Oncol (R Coll Radiol) 2009;21(8):591–597
  • 55 Brigante G, Riccetti L, Lazzaretti C. et al. Abacavir, nevirapine, and ritonavir modulate intracellular calcium levels without affecting GHRH-mediated growth hormone secretion in somatotropic cells in vitro. Mol td Endocrinol 2019; 482: 37-44
    CrossrefPubMedGoogle Scholar
  • 56 Zeng J, See AP, Aziz K. et al. Nelfinavir induces radiation sensitization in pituitary adenoma cells. Cancer Biol Ther 2011; 12 (07) 657-663
    CrossrefPubMedGoogle Scholar
  • 57 Wunder DM, Fux CA, Bersinger NA. et al; Swiss HIV Cohort Study. Androgen and gonadotropin patterns differ in HIV-1-infected men who develop lipoatrophy during antiretroviral therapy: a case-control study. HIV Med 2008; 9 (06) 427-432
    CrossrefPubMedGoogle Scholar
  • 58 Rochira V, Diazzi C, Santi D. et al. Low testosterone is associated with poor health status in men with human immunodeficiency virus infection: a retrospective study. Andrology 2015; 3 (02) 298-308
    CrossrefPubMedGoogle Scholar
  • 59 Wanke CA, Silva M, Knox TA, Forrester J, Speigelman D, Gorbach SL. Weight loss and wasting remain common complications in individuals infected with human immunodeficiency virus in the era of highly active antiretroviral therapy. Clin Infect Dis 2000; 31 (03) 803-805
    CrossrefPubMedGoogle Scholar
  • 60 Singh G. Latrogenic nephrogenic diabetes insipidus. AIDS 2003; 17 (09) 1418
    CrossrefPubMedGoogle Scholar
  • 61 D’Ythurbide G, Goujard C, Méchaï F, Blanc A, Charpentier B, Snanoudj R. Fanconi syndrome and nephrogenic diabetes insipidus associated with didanosine therapy in HIV infection: a case report and literature review. Nephrol Dial Transplant 2007; 22 (12) 3656-3659
    CrossrefPubMedGoogle Scholar
  • 62 Imai K, Sutton MY, Mdodo R. Del Rio C. HIV and menopause: a systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy. Obstet Gynecol Int 2013; 2013: 340309
    CrossrefPubMedGoogle Scholar
  • 63 Karim R, Mack WJ, Kono N. et al. Gonadotropin and sex steroid levels in HIV-infected premenopausal women and their association with subclinical atherosclerosis in HIV-infected and -uninfected women in the women’s interagency HIV study (WIHS). J Clin Endocrinol Metab 2013; 98 (04) E610-E618
    CrossrefPubMedGoogle Scholar
  • 64 Pebody R. Menopause and HIV; 2017. aidsmap.com. Available at: http://www.aidsmap.com/about-hiv/menopause-and-hiv. Accessed June 13, 2020
  • 65 Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI. et al. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: dyslipidemia as a main risk factor. Sex Med 2014; 2 (01) 24-30
    CrossrefPubMedGoogle Scholar
  • 66 Kongnyuy EJ, Wiysonge CS. Association between fertility and HIV status: what implications for HIV estimates?. BMC Public Health 2008; 8 (01) 309
    CrossrefPubMedGoogle Scholar
  • 67 Kushnir VA, Lewis W. Human immunodeficiency virus/acquired immunodeficiency syndrome and infertility: emerging problems in the era of highly active antiretrovirals. Fertil Steril 2011; 96 (03) 546-553
    CrossrefPubMedGoogle Scholar
  • 68 Fiorot Costalonga E, Weberling Coelho Moreira A, Morais Borges F. et al. Nephrogenic diabetes insipidus as the first manifestation of ectopic ACTH syndrome in a HIV infected patient. Int Arch Med 2016; 9: ISSN 1755–7682
    Google Scholar
  • 69 Juffermans NP, Verbon A, Van der Poll T. Diabetes insipidus as a complication of cryptococcal meningitis in an HIV-infected patient. Scand J Infect Dis 2002; 34 (05) 397-398
    CrossrefPubMedGoogle Scholar