Endocrine Abstracts

Infection with HIV may be complicated by hypoinsulinaemic hypoglycaemia. We report, for the first time, a case of hyperinsulinaemic hypoglycaemia in a pregnant woman with HIV. A 30 year old patient was diagnosed to have AIDS during the 8th week of her fourth pregnancy and was commenced on standard antiretroviral therapy. At 27 weeks of pregnancy she presented with a grand mal seizure and was found to be hypoglycaemic with venous blood glucose of 1.2mmol/L with inappropriately high serum insulin(68pmol/L), C peptide (704pmol/L) and proinsulin (36pmol/L) levels. Pituitary and adrenal functions were normal. Serum sulphonylurea screen and insulin antibodies were negative. Pancreatic imaging was normal. Serum amylase was elevated at 137U/L (reference range <100U/L). Despite withdrawal of antiretroviral therapy she continued to experience persistent hypoglycaemia, which required continuous dextrose infusion. After three weeks of persistent hypoglycaemia, blood glucose concentrations gradually normalized spontaneously and there was no recurrence. At 38weeks of pregnancy, a healthy baby was delivered following an uncomplicated elective caesarean section. During the postpartum period, prolonged fasting with exercise on several occasions failed to provoke hypoglycaemia and an oral glucose load test showed normal glucose tolerance. Repeat MRI scan of pancreas failed to reveal any focal pathology. HIV infection is associated with several endocrinopathies, which may be complicated by hypoinsulinaemic hypoglycaemia. However in our patient, these were excluded by the inappropriately high circulating levels of hormones secreted by the pancreatic beta cells. Drug induced and autoimmune causes for hypoglycaemia were also excluded by appropriate tests. Insulinoma was unlikely in view of normal pancreatic imaging, self limiting course and the subsequent failure to provoke hypoglycaemia. Since HIV infection is associated with nonspecific inflammation of the pancreas, we suggest that transient inappropriate hyperinsulinaemia due to beta cell inflammation should be recognised as a cause of hypoglycaemia in a patient with HIV infection.