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28 - Endocrine disorders
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- By Daina Dreimane, Childrens Hospital, Los Angeles, CA, Mitchell E. Geffner, Childrens Hospital, Los Angeles, CA
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
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- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 630-636
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- Chapter
- Export citation
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Summary
Primary endocrinopathies in children with HIV infection are relatively uncommon. Hypothalamic–pituitary function is rarely affected. True endocrine dysfunction in HIV infection usually results from infection or malignancy affecting specific glandular function or from the side effects of pharmacological agents on hormone synthesis or action.
Growth failure and pubertal delay
Growth failure [1–3] occurs in 20%–80% of symptomatic HIV-infected children. Among perinatally infected children, it presents as early as 6 months of age. As the HIV infection becomes more advanced, growth failure may progress to a distinct wasting syndrome.
Proposed mechanisms of growth failure
Mechanisms include the non-specific effects of chronic disease, decreased intake, and enteropathy. Affected children manifest hypermetabolism (increased resting energy expenditure)/catabolism. Hormonal aberrations, while rare, can include deficiencies of growth hormone (GH), sex steroids (during adolescence), and thyroid hormones (see below).
GH/insulin-like growth factor-I (IGF-I) axis
GH deficiency occurs less often than might be predicted, based on the prevalence of AIDS encephalopathy in children. Levels of the GH-dependent surrogates, IGF-I and insulin-like growth factor binding protein-3 (IGFBP-3), even without GH deficiency, are typically low secondary to undernutrition. IGFBP-3 proteolysis also can occur. GH/IGF-I resistance has been documented in vitro [4].
Sex steroid deficiency
Delayed puberty appears to be common in children with HIV infection [5]. The mechanism remains unknown, but is most likely related to the effects of chronic disease.
35 - Endocrine disorders
- from Part IV - Clinical manifestations of HIV infection in children
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- By Daina Dreimane, Childrens Hospital Los Angeles, Los Angeles, CA, Mitchell E. Geffner, Childrens Hospital Los Angeles, Los Angeles, CA
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
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- Book:
- Textbook of Pediatric HIV Care
- Published online:
- 03 February 2010
- Print publication:
- 28 April 2005, pp 530-535
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- Chapter
- Export citation
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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).