Endocrine manifestations of HIV
|Also listed as: HIV and endocrine manifestations||Integrative Therapy Quick Links:|
- Adrenal, adrenal glands, adrenal glucocorticoid, adrenal insufficiency, adrenaline, AIDS, acquired immunodeficiency syndrome, androgen, calcium, diabetes, endocrine, endocrine abnormalities, endocrine glands, endocrine system, endocrinology, glucocorticoid, gonads, HIV, hormones, human autoimmune virus, hypoglycemia, hypogonadism, hyponatremia, hypothalamus, mineralocorticoid, pancreas, pancreatic dysfunction, pituitary, pituitary dysfunction, pituitary gland, rotavirus, sex hormones, sex steroids, sexually transmitted disease, STD, testes, testosterone, thyroid, thyroid abnormalities.
- Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing endocrine abnormalities. The endocrine system is a group of organs that secretes hormones into the bloodstream to regulate bodily functions. The endocrine system includes the adrenal glands, hypothalamus, pituitary gland, thyroid, and gonads (ovaries and testes).
- HIV patients are most likely to develop endocrine abnormalities in response to medications or as a complication of infections or tumors. Common endocrine abnormalities associated with HIV include Addison's disease (adrenal insufficiency), male hypogonadism, pancreatitis, and pituitary dysfunction.
- Many endocrine disorders can be successfully treated. However, prognosis varies depending on the specific disorder.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- Cohan GR. HIV-associated hypogonadism. AIDS Read. 2006 Jul;16(7):341-5, 348, 352-4. .
- Crum NF, Furtek KJ, Olson PE, et al. A review of hypogonadism and erectile dysfunction among HIV-infected men during the pre- and post-HAART eras: diagnosis, pathogenesis, and management. AIDS Patient Care STDS. 2005 Oct;19(10):655-71. .
- Endocrine and Metabolic Diseases Information Service. . Accessed May 13, 2009.
- HIV InSite. . Accessed May 13, 2009.
- National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). . Accessed May 13, 2009.
- Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 13, 2009.
- The Body: The Complete HIV/AIDS Resource. . Accessed May 13, 2009.
- Trivedi CD, Pitchumoni CS. Drug-induced pancreatitis: an update. J Clin Gastroenterol. 2005 Sep;39(8):709-16. .
- Young B, Weidle PJ, Baker RK, et al. Short-term safety and tolerability of didanosine combined with high- versus low-dose tenofovir disproxil fumarate in ambulatory HIV-1-infected persons. AIDS Patient Care STDS. 2006 Apr;20(4):238-44. .
- Good scientific evidence:
- DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Several studies suggest that DHEA may improve well-being, quality of life, exercise capacity, sex drive, and hormone levels in people with adrenal insufficiency. Though promising, additional study is needed to make a strong recommendation. Adrenal insufficiency is a serious medical condition and should be treated under the supervision of a qualified health care professional, including a pharmacist.
- Avoid if allergic to DHEA. Avoid with a history of seizures. Use with cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risk. Avoid if pregnant or breastfeeding.
- Probiotics: Supplementing with Lactobacillus plantarum 299 may help prevent pancreatic infection (sepsis), reduce the number of operations needed, and reduce the length of hospital stay in acute pancreatitis. Additional research is needed to make a conclusion.
- Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
- Unclear or conflicting scientific evidence:
- Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants; it is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Based on early study, it has been suggested that chlorophyll-a may reduce the mortality rate in chronic pancreatitis. Additional study is needed in this area.
- Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
- Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. For many years, danshen has been used as a traditional Chinese medicine (TCM) remedy to treat acute pancreatitis. However, little scientific research is currently available regarding the use of danshen in humans.
- Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives including ACE inhibitors such as captopril, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure, and following cerebal ischemia. Avoid if pregnant or breastfeeding.
- Grape seed: Limited available human study suggests that grape seed may reduce abdominal pain in chronic pancreatitis. Further research is needed.
- Reports exist of people with allergy to grapes or other grape compounds, including anaphylaxis. Individuals allergic to grapes should not take grape seed and related products. Use cautiously if taking anticoagulants. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Grape seed may interfere with the way the body processes certain drugs that use the liver's cytochrome P450 enzyme system. Avoid if pregnant or breastfeeding.
- Licorice: Licorice is harvested from the root and dried rhizomes of the low-growing shrub Glycyrrhiza glabra. Licorice has been used historically for adrenal insufficiency. In theory, there may be some benefits of licorice for high potassium levels resulting from abnormally low aldosterone levels. There is early evidence in humans in support of this use. However, research is preliminary and a qualified healthcare provider should supervise treatment.
- Avoid licorice if allergic to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney disease, liver disease, fluid retention, high blood pressure, or hormonal abnormalities. Avoid if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
- Selenium: There is currently inconclusive evidence regarding the use of selenium in pancreatitis. Additional study is needed in this area.
- Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
- Traditional or theoretical uses lacking sufficient evidence:
- Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Electroacupuncture, which involves needles that send electrical currents into the skin, has been suggested as a possible treatment for pancreatitis. However, there is currently insufficient available evidence on the safety and efficacy of this treatment in humans. Further research is needed before a firm conclusion can be made.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with a history of seizures.
- Astragalus: Preliminary research reports that Astragalus containing herbal formulas may protect adrenal function, however the effect of Astragalus on adrenal insufficiency is currently unknown. Additional research is needed.
- Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, diuretics, or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
- Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractic therapy has been suggested as a beneficial treatment for patients with pancreatitis. However, a firm conclusion cannot be reached until further research is conducted.
- Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers.
- Ginseng: Ginseng has been traditionally used as an adrenal tonic, and in laboratory study has demonstrated adrenal stimulating effects. High quality clinical study is warranted to better understand ginseng's effect on adrenal function.
- Avoid ginseng with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
- Lycopene: Lycopene is found in tomatoes and it is present in human serum, liver, adrenal glands, lungs, prostate, colon, and skin. It remains unclear whether lycopene is a safe and effective treatment for patients with chronic pancreatitis. Further research is warranted.
- Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
- Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. Physical therapists use a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Traditionally, physical therapy has been used to treat pancreatitis. However, further research in humans is necessary to determine whether this treatment is safe and effective in humans.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used during pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Overview: Addison's disease, also called adrenal insufficiency or hypocortisolism, is a rare endocrine (hormonal) disorder that is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and occasional darkening of the skin.
- The adrenal glands, located just above each of the two kidneys, secrete cortisol, also called hydrocortisone. Cortisol regulates proper glucose metabolism, blood pressure, and insulin release for blood sugar maintenance. It is also involved in the inflammatory response. When the adrenal glands do not produce enough cortisol, symptoms of Addison's disease develop.
- Causes: Most cases of Addison's disease in HIV patients are caused by medications. Certain drugs used to treat patients with advanced HIV disease may affect adrenal function and cause adrenal insufficiency. For instance, an antifungal called ketoconazole (Nizoral®) has been shown to inhibit the production of cortisol. This drug prevents the adrenal glands from responding to a hormone called adrenocorticotropic hormone (ACTH). Normally, when the pituitary gland secretes ACTH, the adrenal glands are stimulated to produce cortisol. However, patients taking this drug may not produce cortisol in response to ACTH.
- Rifampin (Rifadin®, Rimactane®), a drug used to treat tuberculosis infections that are often associated with HIV, changes the way the body breaks down cortisol in the body. As a result, the body needs higher levels of cortisol in order for the hormone to have proper effects on the body.
- Symptoms: Symptoms of Addison's disease usually go unnoticed until about 90% of the adrenal cortex has been destroyed. Common symptoms include fatigue, decreased appetite, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness, dizziness when standing, dehydration, anxiety, and depression. Some patients may also experience increased bronze pigmentation of the skin and mucous membranes, as well as decreased tolerance to cold. Women may lose pubic and underarm hair and may stop having normal menstrual periods.
- Diagnosis: If it is suspected that a patient has Addison's disease, a healthcare provider may measure the cortisol levels of the patient's blood in the morning. Healthy individuals typically have plasma cortisol levels that range from 5-23 micrograms per deciliter of blood. Plasma cortisol levels less than 10 micrograms per deciliter of blood are suggestive of Addison's disease.
- The standard diagnostic test for Addison's disease is the adrenocorticotropic hormone (ACTH) stimulation test. The adrenocorticotropic hormone (ACTH) test measures the level of cortisol in the blood and urine 30-60 minutes before and after an injection of man-made ACTH. Individuals who do not have adrenal damage will begin producing cortisol in response to the injection. Patients with Addison's disease will produce minimal or no cortisol in response to the injection.
- The physician may also perform a computerized tomography (CT) scan of the abdomen to check the size of the adrenal glands and look for other abnormalities that might give insight to the cause of adrenal insufficiency.
- Treatment: If a medication is causing Addison's disease, the patient should slowly taper off the medication under the supervision of a healthcare provider. Prolonged suppression of the adrenal glands can lead to atrophy (shrinkage) and may take several weeks to months for the patient to recover to full function after the drug is discontinued. Since patients with Addison's disease do not produce enough hormones, treatment may include one or more hormones to replace the deficiency. Corticosteroids, such as hydrocortisone (A-hydroCort®, Cortef®, Hydrocortone®, Hydrocortone® Acetate, Hydrocortone® Phosphate, and Solu-Cortef®) are used to replace cortisol. Mineralocorticoids, such as fludrocortisone (Florinef®), are used to replace aldosterone.
- Prevention: Ketoconazole and rifampin should be used cautiously and adrenal function should be monitored.
- Overview: Male HIV patients have an increased risk of developing hypogonadism. Hypogonadism is a condition in which the sex organs, also called gonads, are underactive.
The gonads (testes or ovaries) help the body maintain normal physiological function. They secrete hormones essential for reproductive function, development of secondary sexual characteristics, body composition, and mood.
- Primary hypogonadism occurs when the gonads are directly affected. Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland, are causing the gonads to be underactive.
- Hypogonadism is prevalent among men with HIV, according to researchers. In early studies, more than half of all men with AIDS had low testosterone levels. It is estimated that males with advanced HIV disease have a lower prevalence of 25% for hypogonadism than men with less advanced HIV.
- Causes: Hypogonadism may develop in males if HIV affects the hypothalamus, pituitary gland, and/or the testes, causing a decrease in testosterone levels.
- In rare cases infections (such as toxoplasmosis) or HIV-related cancers (such as lymphoma) have been shown to cause lesions on the pituitary gland and/or hypothalamus. These lesions may prevent the pituitary and hypothalamus from secreting hormones necessary for proper gonadal function.
- In addition, certain medications may also cause secondary hypogonadism in HIV-infected males. For instance, a man-made hormone called egestrol acetate (such as Megace®) may cause severe hypogonadism in HIV-infected males.
- Malnutrition and/or chronic illness may cause secondary hypogonadism in HIV-infected men.
- Symptoms: If the body does not produce enough testosterone during fetal development, the growth of male sex organs may be impaired. Male children born with HIV and hypogonadism may have female genitals, ambiguous genitals that are neither male or female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and lack of deepening of the voice. Hypogonadism during adulthood may cause erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).
- Diagnosis: Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of testosterone in the blood. If tests confirm that the patient has low levels of testosterone, hypogonadism is diagnosed. Additional tests may be performed to determine the underlying cause. If a patient with hypogonadism is receiving hormone therapy, the medication is the suspected cause.
- A blood test is performed to measure the levels of testosterone in the blood. This test is typically performed early in the day because testosterone levels are generally highest in the morning. Healthy males typically have 300-1,000 nanograms of testosterone per deciliter of blood.
- Treatment: HIV patients typically experience an improvement in symptoms once the underlying cause is treated.
- If hormone replacement therapy is the suspected cause of symptoms, a healthcare provider may recommend a different dose or medication.
- If HIV is the suspected cause, patients should begin treatment with highly active antiretroviral therapy (HAART). This is a combination of different antiretrovirals that suppresses HIV and boosts the body's immune system.
- If an infection is the suspected cause, patients typically receive medications called antimicrobials. Antibiotics are used to treat bacterial infections, antifungals are used to treat fungal infections, and antivirals are used to treat viral infections. The specific drug and dose depend on the type and severity of the infection, as well as the patient's overall health.
- Only in rare cases do HIV patients require testosterone injections. This is because most HIV patients with hypogonadism do not experience testicular failure. If testosterone therapy is needed, patients typically receive injections with the hormone once every two to three weeks.
- Prevention: Since most cases of hypogonadism in HIV patients are caused by infections, patients should receive HAART. This combination therapy suppresses HIV, which subsequently boosts the immune system, making patients less vulnerable to infections.
- Overview: Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing pancreatitis, a severe inflammation of the pancreas. Pancreatitis occurs when the digestive enzymes in the organ become active too soon. Instead of becoming active in the intestines, they become active inside the pancreas, where they can cause organ damage.
- The pancreas is located behind the stomach. It produces enzymes that are released into the small intestine to break down protein in food. The pancreas also produces insulin, a hormone that helps regulate the amount of sugar in the blood.
- Although HIV patients are more likely to develop pancreatitis than HIV-negative patients, it is still considered a rare condition. For instance, researchers from one study found that less than one percent of 976 HIV patients who were receiving anti-HIV drugs (antiretrovirals) developed the condition.
- Causes: HIV patients may develop pancreatitis as a result of heavy alcohol consumption, gallstones that block a tube in the pancreas called the pancreatic duct, infections (such as mycobacterium avium complex), or medications such as pentamidine (Pentam®).
- Symptoms: Acute symptoms of pancreatitis appear suddenly and may lasts for several hours or even days. Common symptoms include nausea, rapid pulse, fever, vomiting, and severe abdominal pain and swelling. The abdomen may be tender when touched. Drinking alcohol causes the symptoms to worsen.
- If the underlying cause of pancreatitis is not treated, the condition may become chronic (long-term). Common symptoms of chronic pancreatitis include nausea, vomiting, fever, and unintentional weight loss. Chronic pancreatitis may lead to complications, such as temporary diabetes, malnutrition, and severe pain.
- Diagnosis: A blood test may be performed to determine whether the digestive enzymes from the pancreas are present in the blood. Patients with pancreatitis will test positive for these enzymes. This is because the enzymes in the pancreas leak outside of the organ and into the bloodstream.
- Imaging studies, such as an abdominal X-ray or computerized tomography (CT) scan, may be performed to determine whether the pancreas is larger than normal. Both of these tests, which are performed at the hospital, produce images of the internal organs. Patients with pancreatitis will have an inflamed pancreas.
- An endoscopic retrograde cholangiopancreatography (ERCP) may be performed at the hospital to evaluate the damage of the pancreas. During the procedure, a thin, flexible tube with a camera is inserted through the mouth and into the small intestine. The tube then hooks into the bile duct, allowing the healthcare provider to see the pancreas. During the test, a small tissue sample may be removed and analyzed in a laboratory for infections or cancer. Because this procedure may damage the pancreas if not performed by a qualified physician, it is only conducted if all other tests are nondiagnostic. There is also a slight risk of infection.
- Treatment: Acute pancreatitis usually improves after about one week of treatment. Most cases of acute pancreatitis require hospitalization for a few days, and patients typically experience a full recovery. However, if the condition is left untreated, scarring may occur in the organ. Once the organ becomes scarred, the condition cannot be reversed and the patient requires long-term treatment to manage the symptoms. Alcohol avoidance and pain medications can effectively relieve symptoms of chronic pancreatitis.
- If a medication is suspected to be causing acute pancreatitis, a healthcare provider may recommend an alternative dose or medication.
- Oral pain relievers, such as meperidine (Demerol® Hydrochloride), have been used to treat pain caused by pancreatitis. Oral anti-inflammatories, such as naproxen (Naprosyn®, Synflex®), or high doses of aspirin may also help reduce pain.
- Antimicrobials are used to treat infections that cause pancreatitis. Antibiotics are used to treat bacterial infections, antifungals are used to treat fungal infections, and antivirals are used to treat viral infections.
- If a gallstone is causing acute pancreatitis, a surgical procedure called endoscopic sphincterotomy is usually required. This procedure is used if the gallstone is blocking the biliary ducts. During the procedure, which is performed at a hospital, the patient receives general anesthesia and is asleep during the surgery. Then, a thin flexible tube, called an endoscope, is inserted through the patient's anus. Additional surgical tools are inserted through the tube to remove the gallbladder. Once the gallbladder is removed, patients can expect a full recovery. Some patients may experience more frequent bowel movements and/or loser-than-normal stools or diarrhea. In some cases, these symptoms may gradually improve over time. Complications are rare but may include damage to the common bile duct, bleeding, and infection. Non-surgical procedures, such as bile salt tablets or sound wave therapy, are only considered if the patient is unable to undergo surgery or the stone is primarily made up of cholesterol. This is because gallstones usually recur when non-surgical procedures are used.
- Patients with chronic pancreatitis typically receive enzyme therapy with supplements, such as pancrelipase (Pancrease®, Viokase®). These are man-made versions of the pancreatic enzymes that are leaking out of the organ. These supplements are typically taken before and during meals and snacks.
- Because the pancreatic enzymes may damage the cells that produce insulin, insulin injections may be given to patients who are experiencing symptoms of diabetes.
- In severe cases, patients may undergo a surgical procedure to destroy the nerves near the pancreas. Once the nerves are dead, they can no longer transmit pain signals to the brain and the patient does not feel pain. Surgery is only performed in patients who have severe pain that cannot be managed with other treatments.
- Prevention: Avoid or minimize alcohol consumption because it may lead to pancreatitis. Patients should eat a reduced fat diet. High amounts of fat increase the risk of developing gallstones and gallstones may cause pancreatitis. Patients should receive highly active antiretroviral therapy (HAART) to help prevent infections that may cause pancreatitis. HAART is a combination of anti-HIV drugs (antiretrovirals) that suppresses HIV and boosts the body's immune system. In order to prevent complications of pancreatitis, patients should take medications exactly as prescribed.
- Overview: There have been reports of pituitary disorders in HIV/AIDS patients. The pituitary gland is a pea-sized gland located at the base of the brain. This gland secretes various hormones that regulate bodily functions, including growth. A part of the brain, called the hypothalamus, releases hormones that control the function of the pituitary gland.
- There have been reports of HIV patients who developed underactive pituitary glands in response to a parasitic infection called toxoplasmosis. This has occurred when the parasite infiltrates the pituitary gland and forms lesions. As a result, the pituitary gland is unable to function properly.
- The most common pituitary disorder associated with HIV is hyponatremia. This condition occurs when the patient has low levels of sodium in the blood. The pituitary gland and hypothalamus are involved in sodium regulation. They produce and release antidiuretic hormone (ADH) into the bloodstream. This hormone causes the kidneys to conserve water. Patients develop hyponatremia if too much water is conserved.
- According to one study, more than 50% of hospitalized patients with advanced HIV had hyponatremia.
Although hyponatremia is most common among acutely ill, hospitalized HIV patients with opportunistic infections, studies have also found that the incidence among stable HIV outpatients is also high, about 20%.
- Causes: Some infections commonly associated with HIV, such as toxoplasmosis, may lead to an underactive pituitary gland. This happens when the infection causes lesions to form on the pituitary gland. Consequently, the gland is unable to secrete enough hormones needed for proper function.
- Hyponatremia in HIV patients may be caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH), according to one study. This syndrome is characterized by excessive levels of antidiuretic hormone (ADH) in the bloodstream. Stress or medications are most likely to cause SIADH. Many HIV patients who developed hyponatremia were taking either opiate or barbiturate medications, which are known to stimulate the production of ADH.
- In addition, low levels of blood in the body can also stimulate the pituitary gland to secrete more ADH. One study found that 88% of HIV patients with hyponatremia had decreased levels of blood circulating in the body in response to intravenous saline solution. HIV patients with severe infections often receive intravenous saline at the hospital.
- Symptoms: Symptoms of an underactive pituitary gland vary depending on the affected hormones and severity of the deficiency. In general, symptoms may include sensitivity to cold, fatigue, weakness, decreased appetite, weight loss, abdominal pain, low blood pressure, headache, and vision problems.
- Symptoms of hyponatremia may include fatigue, disorientation, headache, muscle cramps, and nausea. Extremely low levels of sodium can cause serious effects, including seizures and coma.
- Diagnosis: A blood test is performed to diagnose an underactive pituitary gland. A healthcare provider will measure the amount of pituitary hormones present in the blood. Low or nonexistent levels of one or more pituitary hormones indicate an underactive thyroid.
- Several blood and urine tests are available to diagnose hyponatremia. A serum sodium blood test may be conducted to determine the amount of sodium in the fluid portion of the blood, called the serum. Healthy patients typically have 135-145 milliequivalents of sodium per liter of blood. Patients with hyponatremia have less than 135 milliequivalents of sodium per liter of blood.
- A serum osmolality test measures the amount of chemicals, including sodium, that are dissolved in the serum. Serum osmolality is controlled partly by ADH, also called vasopressin. The normal osmolality of blood is 275-295 milliosmoles per kilogram. Low serum osmolality indicates hyponatremia.
- A urine osmolality test measures the amount of chemicals, including sodium, that are dissolved in the urine.
The normal osmolality of urine is 50-1,400 milliosmoles per kilogram. A urine sodium test measures the amount of sodium in urine.
Urine is collected over a 24-hour period and then analyzed in a laboratory. Normal urine sodium values are 15-250 milliequivalents per liter of urine a day.
- Treatment: Treatment for an underactive pituitary gland varies depending on the severity of the condition and specific type of hormone deficiency. Some patients may return to normal function once the underlying infection is treated. Some patients may also require treatment with hormone therapy.
- Patients who have hyponatremia that is caused by diuretics or an abnormal increase in ADH do not usually require medical treatment. Instead, the patient is encouraged to drink less water each day.
- Injecting a solution of 5% sodium chloride into the bloodstream can treat severe hyponatremia.
- Prevention: Patients should receive prompt treatment for infections, especially those that may lead to an underactive pituitary gland. Patients receiving either opiate or barbiturate therapy for lung disease should be monitored for hyponatremia
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.