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Have Cushing's syndrome/HIV: couple of questions

May 16, 2004

Dear Doctor Holodniy, Amazingly, I seem to have Cushings or at least some form of hypercortisolism based on repeat 24 hour urine tests (very high cortisol levels) and morning serum cortisol (strangely, afternoon serum cortisol is normal).

Does HIV cause hypercortisolism? And, does high cortiol cause low testosterone? I read that maybe it does, but if that is true - how is it that cortisol is highest in the early mornings, yet sexual libido is also highest in the early mornings?

Many thanks.

Response from Dr. Holodniy

The data on this subject is conflicting. There is wide variability in what is a "normal range". There are several factors that could be contributing to increased cortisol levels. You don't indicate whether you are currently receiving protease inhibitors (like ritonavir), exogenous steroid preparations or have evidence of lipodystrophy. You don't indicate whether other endogenous steroids were measured, or whether a cortisol suppression test was performed to determine if there is truly an endocrine problem. I can't answer the evolutionary question about why cortisol is highest in the morning.

reached undetectable, but CD4 dropped too
Lab results: very high cortisol...caused by HIV itself?

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