SUN-436 Secondary Adrenal Insufficiency in an HIV-positive Patient with Hypogonadism

Abstract Disclosure: M. Uppal: None. J. Khoury: None. C. Baldwin: None. N. El-Asmar: None. Introduction: Individuals with HIV can develop perturbations in both the hypothalamic pituitary gonadal axis (HPG) and less commonly perturbations in the hypothalamic pituitary adrenal axis (HPA) axis. We present a case of central adrenal insufficiency (AI) which developed many years after the onset of central hypogonadism in a patient with HIV and empty sella syndrome. Clinical Case A 73-year-old man with history of HIV diagnosed in 1987 on HAART, well-controlled hypertension, and type 2 diabetes mellitus was referred for evaluation of low cortisol levels. Work up of new-onset hyponatremia revealed low cortisol levels of 0.9 ug/dl [8-19 ug/dL]. There were no acromegalic or cushingoid features on examination. Pituitary hormonal panel revealed IGF-1 307 ng/ml [53-222 ng/mL], TSH 1.8 uIU/ml [0.45-4.5 uIU/mL], FT4 1.2ng/dl [0.82-1.77 ng/dL], FSH 4 mIU/ml [1.5-12.4 mIU/mL], LH 3.1mIU/ml [1.7-8.6 mIU/mL], free cortisol <0.02 ug/dL [0.2-1.8 ug/dL], DHEA sulfate 11.8 ug/dl [30.9-295.6 ug/dL], prolactin 10 ng/mL [3.6-25.2 ng/mL], total testosterone 499.6 ng/dl [264-916 pg/mL], free testosterone 3.2 pg/ml [6.6-18.1 pg/mL], low ACTH 3.8 pg/ml [7.2-63.3 pg/mL]. The patient was on transdermal testosterone therapy at the time and denied exogenous glucocorticoid exposure. He was started on hydrocortisone with significant improvement in energy, weight, and resolution of hyponatremia. He denied history of headaches, opioid use, head trauma, or night sweats. Oral glucose tolerance test was performed due to elevated IGF-1 with appropriate suppression of growth hormone levels. MRI pituitary revealed a partially empty sella and a 4 mm possible pituitary microadenoma. He currently continues to do well on hydrocortisone and testosterone replacement. Conclusion: Hypogonadism can occur in individuals with HIV in a multifactorial pathogenic process involving direct effects of the virus, antiretroviral therapy (ART), or comorbidities like severe undernutrition. Hypogonadotropic hypogonadism with low or inappropriately normal gonadotropin levels but reduced free testosterone is the most common type. Adrenal insufficiency; primary or secondary, may also occur in HIV-infected patients via dysregulation of the HPA axis through direct invasion of the adrenal glands’ tissue, chronic inflammation, or effects of ART. We present a unique case of chronic HIV, empty sella syndrome, along with hypogonadism and adrenal insufficiency with the former predating the latter by many years. Presentation: Sunday, July 13, 2025