Endocrine disorders

doi:10.1017/CBO9780511544798.038

35 - Endocrine disorders

from Part IV - Clinical manifestations of HIV infection in children

Published online by Cambridge University Press: 03 February 2010

Daina Dreimane and

Mitchell E. Geffner

Edited by

Steven L. Zeichner and

Jennifer S. Read

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Daina Dreimane: Affiliation:
Childrens Hospital Los Angeles, Los Angeles, CA
Mitchell E. Geffner: Affiliation:
Childrens Hospital Los Angeles, Los Angeles, CA
Steven L. Zeichner: Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read: Affiliation:
National Cancer Institute, Bethesda, Maryland

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Summary

Although growth failure is common among HIV-infected children, especially those with more advanced disease, primary endocrinopathies are relatively uncommon. Also, despite the prevalence of encephalopathy among HIV-infected children, hypothalamic-pituitary function is rarely affected. Highly active antiretroviral therapy (HAART) with protease inhibitors (PIs) can cause specific derangements of body composition and metabolism. When true endocrine dysfunction occurs in HIV-infected children, it usually results either from infection or malignancy affecting specific glandular function or from the effects of pharmacological agents on hormone synthesis or action.

Growth failure (failure-to-thrive) and pubertal delay

Growth failure [1–3] occurs in 20–80% of symptomatic HIV-infected children regardless of route of acquisition. In perinatally infected children, failure-to-thrive (FTT) presents as early as 6 months of age. As the infection becomes more advanced, growth failure may progress to a distinct wasting syndrome (analogous to that which occurs in adults).

Proposed mechanisms of growth failure

Mechanisms include the non-specific effects of chronic disease, decreased intake (anorexia, esophagitis, and abdominal pain), and enteropathy (diarrhea, malabsorption, and gut infection)[2]. In addition, affected children manifest hypermetabolism (increased resting expenditure)/ catabolism. Their caloric intake, even if normal or increased for age, may not meet their energy needs. Hormonal aberrations also have been implicated, including deficiencies of growth hormone (GH), sex steroids (during adolescence), and thyroid hormones (see below).

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Type: Chapter
Information: Textbook of Pediatric HIV Care , pp. 530 - 535

DOI: https://doi.org/10.1017/CBO9780511544798.038 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

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References

Geffner, M. E., Dop, C., Kovacs, A. A.. Intrauterine and postnatal growth in children born to women infected with Human Immunodeficiency Virus. Pediatr. Acquired Immune Deficiency Syndrome Human Immunodeficiency Virus Infect. 5 (1994), 162–8Google Scholar

Frost, R. A., Lang, C. H. & Gelato, M. C.Growth hormone/ insulin-like growth factor axis in human immunodeficiency virus-associated disease. Endocrinologist 7 (1997), 23–31CrossRef Google Scholar

Miller, T. L., Easley, K. A., Zhang, W.. Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: the prospective P2C2 human immunodeficiency virus multicenter study. Pediatrics 108 (2001), 1287–96CrossRef Google Scholar PubMed

Geffner, M. E., Yeh, D. Y., Landaw, E. M., Scott, M. L., Stiehm, E. R., Bryson, Y. J. & Israele, V., In vitro insulin-like growth factor-I, growth hormone, and insulin resistance occurs in symptomatic human immunodeficiency virus-1-infected children. Pediatr. Res. 34 (1993), 66–72CrossRef Google Scholar PubMed

Martino, M., Tovo, P., Galli, L.. Puberty in perinatal Human Immunodeficiency Virus-1 infection: a multicentre study of 212 children. Acquired Immune Deficiency Syndrome 15 (2001), 1527–34Google Scholar PubMed

Mahoney, E., Donfield, S. M., Howard, C., Kaufman, F., Gertner, J. M. and the Hemophilia Growth and Development Study. Human Immunodeficiency Virus-associated immune dysfunction and delayed pubertal development in a cohort of young hemophiliacs. J. Acquired Immune Deficiency Syndrome 21 (1999), 333–7CrossRef Google Scholar

Balter-Seri, J. & Ashkenazi, S.The effects of infectious diseases on the endocrine system. J. Pediatr. Endocrinol. Metab. 10 (1997), 245–56CrossRef Google Scholar PubMed

Grinspoon, S.Neuroendocrine manifestations of Acquired Immune Deficiency Syndrome. Endocrinologist 7 (1997), 32–8CrossRef Google Scholar

Clarick, R. H., Hanekom, W. A., Yogev, R. & Chadwick, G. E.Megestrol acetate treatment of growth failure in children infected with human immunodeficiency virus. Pediatrics 99 (1997), 354–7CrossRef Google Scholar PubMed

Dreimane, D., Nielsen, K., Deveikis, A., Bryson, Y. J. & Geffner, M. E.Effect of protease inhibitors combined with standard antiretroviral therapy on linear growth and weight gain in human immunodeficiency virus type-1 infected children. J. Pediatr. Infect. Dis. 20 (2001), 315–16CrossRef Google Scholar PubMed

Schambelan, M., Mulligan, K., Grunfeld, C., Daar, E. S., LaMarca, A. & Kotler, D. P.Recombinant human growth hormone in patients with Human Immunodeficiency Virus-associated wasting. Ann. Intern. Med. 125 (1996), 873–82CrossRef Google Scholar

Hirschfeld, S.Use of human recombinant growth hormone and human recombinant insulin-like growth factor-I in patients with human immunodeficiency virus infection. Hormon. Res. 46 (1996), 215–21CrossRef Google Scholar PubMed

Laue, L., Pizzo, P. A., Butler, K. & Cutler, G. B. JrGrowth and neuroendocrine dysfunction in children with acquired immunodeficiency syndrome. J. Pediatr. 117 (1990), 541–5CrossRef Google Scholar PubMed

Hirschfeld, S., Laue, L., Cutler, G. B. Jr & Pizzo, P. A.Thyroid abnormalities in children infected with human immunodeficiency virus. J. Pediatr. 128 (1996), 70–4CrossRef Google Scholar PubMed

Heufelder, A. E. & Hofbauer, L. C.Human immunodeficiency virus infection and the thyroid gland. Eur. J. Endocrinol. 134 (1996), 669–74CrossRef Google Scholar PubMed

Fundaro, C., Olivieri, A., Rendeli, C.. Occurrence of anti-thyroid autoantibodies in children vertically infected with Human Immunodeficiency Virus-1. J. Pediatr. Endocrinol. Metab. 11 (1998), 745–50CrossRef Google Scholar

Chiarelli, F., Galli, L., Verrotti, A., di Ricco, L., Vierucci, A. & Martino, M.Thyroid function in children with perinatal human immunodeficiency virus type 1 infection. Thyroid 10 (2000), 499–505Google Scholar PubMed

Arpadi, S. M., Cuff, P. A., Horlick, M., Wang, J. & Kotler, D. P.Lipodystrophy in Human Immunodeficiency Virus-infected children is associated with high viral load and low Cluster of Differentiation4+-lymphocyte count and Cluster of Differentiation4+-lymphocyte percentage at baseline and use of protease inhibitors and stavudine. J. Acquired Immune Deficiency Syndrome 27 (2001), 30–4CrossRef Google Scholar

Melvin, A. J., Lennon, S., Mohan, K. M. & Purnell, J. Q.Metabolic abnormalities in Human Immunodeficiency Virus type-1-infected children treated and not treated with protease inhibitors. Acquired Immune Deficiency Syndrome Res. Hum. Retrovirus. 17 (2001), 1117–23Google Scholar

Carr, A., Samaras, K., Chisholm, D. J. & Cooper, D. A.Pathogenesis of Human Immunodeficiency Virus-1-protease inhibitor-associated peripheral lipodystrophy, hyperlipidemia, and insulin resistance. Lancet 531 (1998), 1881–3CrossRef Google Scholar

Danoff, A.Endocrinologic complications of Human Immunodeficiency Virus infection. Med. Clin. N. Am. 80 (1996), 1453–69CrossRef Google Scholar

Sellmeyer, D. E. & Grunfeld, C.Endocrine and metabolic disturbances in human immunodeficiency virus infection and acquired immune deficiency syndrome. Endocr. Rev. 17 (1996), 518–32Google Scholar

Oberfield, S. E., Kairam, R., Bakshi, S.. Steroid response to adrenocorticotropin stimulation in children with human immunodeficiency virus infection. J. Clin. Endocrinol. Metab. 70 (1990), 578–81CrossRef Google Scholar PubMed

Yanovski, J. A., Miller, K. D., Kino, T., Friedman, T. C., Chrousos, G. P. & Falloon, J.Endocrine and metabolic evaluation of human immunodeficiency virus-infected patients with evidence of protease inhibitor-associated lipodystrophy. J. Clin. Endocrinol. Metab. 84 (1999), 1925–31CrossRef Google Scholar PubMed

Kilby, J. M. & Tabereaux, P. B.Severe hyperglycemia in an Human Immunodeficiency Virus clinic: pre-existing versus drug-associated diabetes mellitus. J. Acquired Immune Deficiency Syndrome Hum. Retrovirol. 17 (1998), 46–50CrossRef Google Scholar

Dube, M. P., Johnson, D. L., Currier, J. S. & Leedom, J. M.Protease inhibitor-associated hyperglycaemia. Lancet 2 (1997), 713–14CrossRef Google Scholar

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