ABSTRACT
A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.
Subject(s)
Adenoma/metabolism , Adrenocorticotropic Hormone/deficiency , Human Growth Hormone/deficiency , Hydrocortisone/deficiency , Hypopituitarism/diagnosis , Pituitary Neoplasms/metabolism , Adenoma/pathology , Adrenocorticotropic Hormone/metabolism , Female , Glucagon , Human Growth Hormone/metabolism , Humans , Hydrocortisone/metabolism , Hypopituitarism/etiology , Hypopituitarism/physiopathology , Incidental Findings , Magnetic Resonance Imaging , Middle Aged , Pituitary Neoplasms/pathology , Pituitary-Adrenal System/physiopathology , Symptom Assessment , Treatment Refusal , Tumor BurdenABSTRACT
INTRODUCTION: The total number of patients with Human Immunodeficiency Virus (HIV) is 33 million, with 2.7 million new infections in 2007(1). Puerto Rico has an increasing prevalence trend of Diabetes Mellitus of 12.8% in 2010(3). As treatment of HIV continues to develop, and access to therapy improves, the incidence of HIV associated diabetes is bound to grow. We investigate the prevalence of Diabetes Mellitus and its associated risk factors in a determinate HIV positive population. MATERIALS AND METHODS: A retrospective study, reviewing the medical records of 146 HIV positive patients. The prevalence of DM was statistically measured and a Logistic Regression with Pearson Χ2 Square and Fisher's exact test was used to assess the association between DM and its risks factors. RESULTS: The prevalence of DM in the studied population was 13.7% (n=20). There were 59% (n = 86) males, 43% (n = 63) of patients treated with HAART 46% (n = 67) IVDA, the mean age was 47; with 29% older than 50 years old, and 68% of the patients had a BMI of less than 25. Gender, IVDA, HAART, BMI, and age were not associated as risk factors for the prevalence of DM in the studied population. DISCUSSION: Our data revealed a higher prevalence of DM in HIV infected patients. We observed no significant association between DM and its risks factors. This raises concern for yet unrecognized risk factors contributing to a higher prevalence of the disease in this population. Results of our study alert physicians on the importance of DM screening in the HIV positive patient population.
