HIV medications affecting pituitary or adrenal function

Medication	Clinical use	Endocrine dysfunction	Mechanism of action
Glucocorticoids	Antiinflammatory therapy	Exogenous Cushing's syndrome; glucocorticoid deficiency upon discontinuation; hypogonadism	Suppresses hypothalamic-pituitary-adrenal (HPA) axis and hypothalamic-pituitary-gonadal (HPG) axes
HIV protease inhibitors	Antiretroviral therapy (ART)	Hyperprolactinemia	May stimulate lactotrophs directly or inhibit metabolism of other medications
Ketoconazole	Antifungal therapy	Adrenal insufficiency; hypogonadism	Impairs steroid hormone synthesis
Megestrol acetate	Appetite stimulant	Cushing's syndrome (rarely); hyperglycemia; hypogonadism; glucocorticoid deficiency upon discontinuation	Intrinsic glucocorticoid-like and progestational activity
Opiates	Analgesic	Impaired cortisol response to ACTH stimulation; hypogonadism	Alterations in HPA and HPG axes
Ritonavir, Cobicistat	ART pharmacologic booster	Exogenous Cushing's syndrome (with concomitant use of synthetic glucorticoids)	Effects on hepatic cytochromes and drug metabolism
Rifampin	Antimycobacterial therapy	Adrenal insufficiency	Increases metabolic clearance of hormones
Sulfonamides	Antibiotic therapy	Hyporeninemic hypoaldosteronism	Interstitial nephritis

Courtesy of Melissa Weinberg, MD and Morris Schambelan, MD.

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