pituitrin and Acquired-Immunodeficiency-Syndrome

Clinically relevant HP dysfunction occurs infrequently in the course of HIV infection and AIDS, and is usually due to destruction or infiltration of the region by opportunistic infections. However, more subtle defects occur with much greater frequency. Since these impairments, especially in the gonadotrophic and corticotrophic axes, are observed in HIV patients before the development of ARC or AIDS, direct involvement of the hypothalamus or pituitary by the neurotropic HIV virus or by other HIV-mediated factors is possible. Further investigation of hypothalamic and pituitary hormones by provocative means, in addition to assessment of the pulsatile secretion of these hormones, at all stages of HIV infection will be needed to clarify the role of the virus in these individuals.

Topics: Acquired Immunodeficiency Syndrome; Humans; Hypothalamus; Pituitary Gland; Pituitary-Adrenal System; Thyroid Gland; Vasopressins

Hyponatraemia is very common in AIDS patients. It is observed in about 40-50% of hospitalized patients. It may contribute to overall mortality in advanced disease. Vasopressin measurements in these patients basically present two distinct syndromes: hyponatraemia and 'normal' vasopressin levels (i.e. measurable vasopressin) and hyponatraemia with suppressed vasopressin. Hyponatraemia with suppressed vasopressin is very rare and has only been observed in AIDS patients with dementia and primary polydipsia. Hyponatraemia and measurable vasopressin can be also divided into two syndromes. In some patients vasopressin is 'appropriately' elevated, i.e. in those with body fluid losses (diarrhoea) or chronic hypovolaemia (adrenal failure); these patients also present with hyperuricaemia and other signs of low blood volume. In other patients vasopressin is 'inappropriately' elevated in those with no clinical evidence of hypovolaemia (typically characterized by low serum uric acid levels) such as in Pneumocystis carinii pneumonia and other opportunistic infections leading to SIADH. CSWS is a relatively frequent complication in some patients with cerebral infection or tumour. High-dose trimethoprim (for Pneumocystis carinii prevention) acts as an amiloride-like drug and induces a clinical state characterized by hyponatraemia and hyperkalaemia which is indistinguishable from hyporeninaemic hypoaldosteronism. The mechanism of the hyponatraemia caused by other drugs (miconazole, pentamidine, amphotericin, vidarabine) is not as yet known.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Insufficiency; Humans; Hyponatremia; Inappropriate ADH Syndrome; Sodium; Vasopressins; Water-Electrolyte Balance

We report a case of central diabetes insipidus (CDI) in a patient with AIDS due to cytomegalovirus (CMV) infection of the vasopressin-producing areas of the hypothalamus. The clinical diagnosis is established by definitive clinical and laboratory evidence of CDI. Detailed histopathological and immunohistochemical studies establish CMV as the causative agent and demonstrate the deficit of vasopressin in the synthesizing neurons. Physicians caring for patients with AIDS should be aware of CDI and adipsic hypernatremia as potential complications of CMV infection. The case also demonstrates that patients with diabetes insipidus do not have polyuria when glucocorticoid deficiency coexists.

Topics: Acquired Immunodeficiency Syndrome; Adult; Cytomegalovirus Infections; Diabetes Insipidus, Neurogenic; Fatal Outcome; Humans; Hypothalamus; Immunohistochemistry; Male; Vasopressins

Computerized Chou-Fasman analysis of the secondary structure of human T-cell leukemia viruses (HTLV-I, HTLV-II) and human immunodeficiency virus (HIV) envelope proteins revealed that only one antigenic epitope (amino acids EAL) is shared by the three viruses. A similar antigenic epitope is also found in human and rat brain hormone vasopressin-neurophysin. If autoantibodies in multiple sclerosis (MS) are made to the epitope EAL, they may cross-react with the envelope proteins of HTVL. It is speculated that in AIDS patients, antibodies to the antigenic epitope EAL of HIV may cross-react with brain vasopressin-neurophysin, leading to a decline in this brain peptide hormone. Thus it is hypothesized that treatment of both MS and AIDS patients with a synthetic polymer containing the amino acids EAL might eliminate the antibodies to vasopressin-neurophysin and thus alleviate some of the clinical symptoms.

Topics: Acquired Immunodeficiency Syndrome; Animals; Antibodies, Viral; Autoantibodies; Cross Reactions; HIV; Humans; Multiple Sclerosis; Neuropeptides; Neurophysins; Vasopressins; Viral Envelope Proteins

Topics: Acquired Immunodeficiency Syndrome; Drug Therapy; Epinephrine; Estrogens; Hemostasis; Humans; Male; Prostatectomy; Transurethral Resection of Prostate; Vasopressins