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Antiretroviral agents, especially protease inhibitors (PIs), have contributed immensely to improving the prognosis of HIV-infected patients. However, as with many therapeutic advances, unexpected toxicities are being encountered as the drugs move to large-scale use.
Three recent reports describe the development of physical features of Cushing's disease in 14 patients receiving HIV protease inhibitors. The most common feature (13 of 14 patients) was dorsocervical fat deposits ("buffalo hump"). A few patients also exhibited truncal obesity. One patient only had increased peritoneal fat. No electrolyte or metabolic features of Cushing's syndrome were reported. In 10 of the 12 patients tested, the 24-hour urine cortisol level was normal, inconsi…