Page 212 - AIDSBK23C

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Hypocalcemia can occur with use of drugs including pentamidine, foscarnet, and ketoconazole.
Hypercalcemia may be related to underlying malignancies, granulomatous disease with
dysregulated extrarenal calcitriol production, opportunistic infection with CMV or
Pneumocystis, and concomitant HTLV-1 infection.[864]

PITUITARY.-- The pituitary gland is affected only infrequently by opportunistic
infections, usually CMV. Lymphomas and Kaposi sarcoma are not seen involving the pituitary
with HIV infection. Microscopic microadenomas or areas of basophilic hyperplasia within
adenohypophysis are seen in up to 10% of AIDS cases at autopsy, though their significance is
not known.[870] Pituitary lesions in AIDS are generally focal and typically not large enough to
decrease pituitary function.
Clinically, hyponatremia is often seen in hospitalized patients with AIDS. In some cases
this results from volume depletion, but in others it is caused by a syndrome of inappropriate
antidiuretic hormone (SIADH) secretion. In most cases, SIADH can be attributed to
opportunistic infections involving lung and brain. The drug vidarabine used to treat patients with
disseminated varicella zoster virus infections may also cause SIADH.[864]
Growth failure and failure to thrive may occur in HIV-infected children. Levels of
insulin-like growth factor 1 (IGF1) and IGF binding protein 3 (IGFBP3) are decreased. Growth
hormone (GH) deficiency inhibits thymic development. Adults with HIV wasting syndrome
there is GH resistance with an increased level of GH, similar to patients with malnutrition. Adult
patients with lipodystrophy had decreased GH along with increased somatostatin, decreased
ghrelin, and increased free fatty acids.[865]