PSEUDO-CUSHINGS-SYNDROME IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

To our knowledge, an association between human immunodeficiency virus infection and pseudo-Cushing's syndrome has not previously been descri bed. We describe four HIV-infected patients with pseudo-Gushing's synd rome, characterized by striking dorsocervical and submandibular fat ac cumulation and central obesity. In each case, cortisol levels were eit her normal or suppressed adequately with administration of dexamethaso ne, excluding the diagnosis of true Gushing's syndrome. Immune functio n and weight improved significantly preceding the development of pseud o-Gushing's syndrome. Three of the four patients were taking a common protease inhibitor at the onset of symptoms, and the fourth reported t he exacerbation of his symptoms with the addition of a protease inhibi tor. The observed characteristic pattern of fat deposition may be attr ibutable to a specific effect of new antiretroviral therapies or may r elate to recovery independent of medication usage. Distinguishing betw een pseudo-Gushing's syndrome and true Gushing's syndrome is critical for preventing the unnecessary and potentially harmful treatment of su ch patients. Further research into the mechanisms of this novel phenom enon is needed.