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.

CONCLUSION

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.