HIV and adrenal function

There is little direct evidence from viral culture for HIV infection in the adrenal glands, but infiltration of endocrine tissues by opportunistic infection or malignancy is common. Loss of adrenocortical function can be difficult to assess, particularly when medications used in the treatment of opportunistic infections result in hormonal or metabolic disturbances. In most cases basal cortisol levels indicate that adrenal function is normal for desperately ill patients. Standard provocative tests, however, may reveal subtle abnormalities of adrenal and pituitary hormone production. Changes in adrenal steroidogenesis do occur, with the result that cortisol production is favored over adrenal androgen and miner-alocorticoid production. Adrenal reserve can be limited. An acquired glucocorticoid resistance may explain high cortisol levels in some cases. Complex interactions between the endocrine and immune systems may influence the progression of HIV infection to AIDS. Further research is necessary to clarify these interactions.