Journal Article

Pseudo-Cushing's Syndrome in Human Immunodeficiency Virus—Infected Patients

Karen K. Miller, Patricia A. Daly, Deborah Sentochnik, John Doweiko, Matthew Samore, Nesli O. Basgoz and Steven K. Grinspoon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 1, pages 68-72
Published in print July 1998 | ISSN: 1058-4838
Published online July 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514638
Pseudo-Cushing's Syndrome in Human Immunodeficiency Virus—Infected Patients

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To our knowledge, an association between human immunodeficiency virus infection and pseudo- Cushing's syndrome has not previously been described. We describe four HIV-infected patients with pseudo-Cushing's syndrome, characterized by striking dorsocervical and submandibular fat accumulation and central obesity. In each case, cortisol levels were either normal or suppressed adequately with administration of dexamethasone, excluding the diagnosis of true Cushing's syndrome. Immune function and weight improved significantly preceding the development of pseudo- Cushing's syndrome. Three of the four patients were taking a common protease inhibitor at the onset of symptoms, and the fourth reported the exacerbation of his symptoms with the addition of a protease inhibitor. The observed characteristic pattern of fat deposition may be attributable to a specific effect of new antiretroviral therapies or may relate to recovery independent of medication usage. Distinguishing between pseudo-Cushing's syndrome and true Cushing's syndrome is critical for preventing the unnecessary and potentially harmful treatment of such patients. Further research into the mechanisms of this novel phenomenon is needed.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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