Hypopituitarism in a HIV Affected Patient

Harbeck, Birgit; Klose, Silke; Buchfelder, Michael; Brabant, Georg; Lehnert, Hendrik

doi:10.1055/s-0031-1284366

Cited by 12 publications

(8 citation statements)

References 19 publications

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“…During the last ten years, reports have shed light on many previously unrecognized causes of pituitary insufficiency [44–46]. Brabant et al have analyzed the etiology of hypopituitarism in more than 13,000 patients from 30 different countries within the KIMS database [42].…”

Section: Discussionmentioning

confidence: 99%

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Doknic

Pekić

Miljić

et al. 2017

International Journal of Endocrinology

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There are only a few published studies related to the population-based etiology of hypopituitarism. New risks for developing hypopituitarism have been recognized in the last 10 years. Aim. To present data regarding the etiology of hypopituitarism collected in a tertiary center over the last decade. This is a cross-sectional database study. Patients and Methods. We included 512 patients (pts) with hypopituitarism, with a mean age of 45.9 ± 1.7 yrs (range: 18–82; male: 57.9%). Results. Nonfunctional pituitary adenomas were presented in 205 pts (40.5%), congenital causes in 74 pts (14.6%), while acromegaly and prolactinomas were presented in 37 (7.2%) and 36 (7.0%) patients, respectively. Craniopharyngiomas were detected in 30 pts (5.9%), and head trauma due to trauma brain injury-TBI and subarachnoid hemorrhage-SAH in 27 pts (5.4%). Survivors of hemorrhagic fever with renal syndrome (HFRS) and those with previous cranial irradiation were presented in the same frequency (18 pts, 3.5% each). Conclusion. The most common causes of hypopituitarism in our database are pituitary adenomas. Increased awareness of the other causes of pituitary dysfunction, such as congenital, head trauma, extrapituitary cranial irradiation, and infections, is the reason for a higher frequency of these etiologies of hypopituitarism in the presented database.

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Section: Discussionmentioning

confidence: 99%

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Doknic

Pekić

Miljić

et al. 2017

International Journal of Endocrinology

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“…In addition, the lack of information regarding the hypothalamo-pituitary morphology does not allow excluding the coexistence of other causes of GHD in these patients. Morphological alterations of the hypothalamic-pituitary region, indeed, have been described to impair pituitary function in HIVinfected patients, but they are usually associated with other symptoms of hypopituitarism (32).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Gender differences in GH response to GHRH+ARG in lipodystrophic patients with HIV: a key role for body fat distribution

Brigante

Diazzi

Ansaloni

et al. 2014

European Journal of Endocrinology

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Objective: Gender influence on GH secretion in human immunodeficiency virus (HIV)-infected patients is poorly known. Design and methods: To determine the effect of gender, we compared GH response to GH-releasing hormone plus arginine (GHRHCArg), and body composition in 103 men and 97 women with HIV and lipodystrophy. The main outcomes were IGF1, basal GH, GH peak and area under the curve (AUC) after GHRHCArg, body composition, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Results: Men had lower GH peak and AUC than women (P!0.001). Of the study population, 21% of women and 37% of men had biochemical GH deficiency (GHD; GH peak !7.5 mg/l). VAT-to-SAT ratio was higher in men than in women with GHD (P!0.05). Unlike women, VAT, SAT, and trunk fat were greater in men with GHD than in men without GHD. IGF1 was significantly lower in women with GHD than in women without GHD, but not in men. At univariate analysis, BMI, trunk fat mass, VAT, and total adipose tissue were associated with GH peak and AUC in both sexes (P!0.05). BMI was the most significant predictive factor of GH peak, and AUC at multiregression analysis. Overall, abdominal fat had a less pronounced effect on GH in females than in males.Conclusions: These data demonstrate that GH response to GHRHCArg is significantly lower in HIV-infected males than females, resulting in a higher percentage of GHD in men. Adipose tissue distribution more than fat mass per se seems to account for GH gender differences and for the alteration of GH-IGF1 status in these patients.

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“…To the extent of our knowledge, only one other case of pituitary abscess in an HIV-1-infected patient has been reported so far. 11 Notably in our case, the pituitary abscess developed while the CD4 T-cell count was within normal ranges. Although we could not detect the causative organism, hematogenous spread from the bacterial paranasal sinusitis was suspected.…”

Section: Discussionmentioning

confidence: 47%

“…3 Many studies have reported cases of brain abscesses and/or encephalitis in HIV-infected patients; 9,10 however, to this day, there is only one report of a pituitary abscess in this category of patients. 11 Here, we report a case of an HIV-1-infected patient who developed a pituitary abscess which was successfully treated with antibiotics only.…”

Section: Introductionmentioning

confidence: 96%

Pituitary abscess in an HIV-1-infected patient

Yamazaki

Kobayashi

Sarca

et al. 2017

SAGE Open Medical Case Reports

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Objectives:Pituitary abscess is a rare occurrence among pituitary conditions, but one which carries life-threatening potential. An immunocompromised status is a risk factor for the development of a pituitary abscess; however, literature describes only one case among HIV-infected patients.Methods and results:We present here a case of pituitary abscess in an HIV-1-positive patient, who demonstrated a shock status, disturbance of consciousness and generalized skin rash with laboratory findings of hypovolemia, acute inflammatory reaction and blood electrolyte abnormality. We first diagnosed the dermal manifestation as atypical generalized zoster, however, the other clinical findings could not be explained by VZV infection only. Combination with anamnesis, head magnetic resonance imaging scan and endocrine function test helped us to diagnose pituitary abscess. Although the etiology of the pituitary abscess could not be detected, the patient was successfully treated with antibiotics but followed by panhypopituitarism as sequela.Conclusion:A pituitary abscess should be considered in HIV-infected patients with endocrinological abnormalities, visual field defects, and central nervous system infection signs or symptoms, regardless of CD4 T-cell counts.

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Hypopituitarism in a HIV Affected Patient

Abstract: A pituitary abscess due to infectious hypophysitis is a rare cause of pituitary failure. Diagnostic signs on imaging may help to rapidly distinguish the cause of pituitary deficiency in patients with HIV infection.

Cited by 12 publications

References 19 publications

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Gender differences in GH response to GHRH+ARG in lipodystrophic patients with HIV: a key role for body fat distribution

Pituitary abscess in an HIV-1-infected patient

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