Adrenal insufficiency in HIV/AIDS: a review

Area of Science:

• Endocrinology
• Infectious Diseases
• HIV/AIDS Medicine

Background:

• Adrenal insufficiency (AI) is a frequent and potentially fatal endocrine complication in people living with HIV/AIDS (PLHIV).
• HIV infection and its treatments can lead to various forms of AI, including primary, secondary, and relative AI, as well as peripheral glucocorticoid resistance.

Purpose of the Study:

• To review the definitions, pathophysiology, etiology, diagnosis, and management of AI in PLHIV.
• To highlight the importance of physician awareness regarding the endocrinological implications of HIV infection and treatment.

Main Methods:

• A comprehensive literature review was conducted.
• Databases searched included Medline and Google Scholar.

Main Results:

• AI in PLHIV can present insidiously with nonspecific symptoms, necessitating a high index of clinical suspicion.
• Overt primary and secondary AI require glucocorticoid replacement, with primary AI also needing mineralocorticoid replacement.
• Management of relative AI is debated, but short-term glucocorticoids may be used during stress to prevent adrenal crisis.

Conclusions:

• Physicians must be vigilant for AI in PLHIV due to the potential for insidious onset and life-threatening consequences.
• Timely diagnosis and appropriate management, including glucocorticoid and mineralocorticoid replacement when indicated, are essential for patient outcomes.
• Further research may be needed to clarify the optimal management strategies for relative AI in this population.