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Endocrine Disorders in Drug Abuse and HIV/AIDS


Adrian Sandra Dobs, M.D., M.H.S.
Johns Hopkins School of Medicine


Lecture Outline

  1. Introduction to the endocrine system
    1. Hypothalamic-pituitary-gonadal axis
    2. Hypothalamic-pituitary-adrenal axis
  2. Associations of the endocrine system with drug use
    1. Opiates
    2. IVDA
    3. Marijuana
    4. HIV infection with or without IVDA
  3. End-organ effects of endocrine abnormalities
    1. Sexual function
    2. Body composition
    3. Cardiovascular
  4. Unanswered questions about endocrine function in IVDA
    1. Verification of abnormalities
    2. Mechanism of abnormalities
    3. Benefits of treating the endocrine imbalance

Lecture Objective

  • To understand the associations among endocrine abnormalities and chronic illness, HIV infection, and drug abuse.

  • To appreciate the effects of these endocrine abnormalities on the prognosis of the underlying illness.

Abstract

Endocrine abnormalities can be primary to organ pathology or secondary to other disease states. Hormonal imbalances secondary to acute or chronic illness is becoming better recognized and appreciated as both a result of illness and a cause of further decline. Very little is known of the hormonal milieu in individuals with IVDA. Older studies suggest declines in serum sex hormones in both men and women. More recent studies have noted increases in ACTH and cortisol, which could result in immunosuppression. The hypogonadism observed in the presence of HIV infection is due to the general effects of chronic illness and the specific actions of drugs and infections unique to the condition. The relationship of low-serum testosterone levels to decreased lean body mass and wasting has presented new opportunities for treatment. The possible benefits of hormonal replacement therapy on body composition is intriguing, but completely untested at this point. A better understanding of the interrelationships of IVDA and hormones is still needed.

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