ECE2016 Eposter Presentations Clinical case reports - Pituitary/Adrenal (81 abstracts)
Iatrogenic cushing syndrome and acute adrenal insufficiency due to the association of inhaled corticosteroids and ritonavir
Ivana Zubillaga 1 , Carla Francés 1 , Joana Nicolau 1 , Pilar Sanchis 1, , Jacobo Blanco 1 , Concepción Conchillo 1 & Lluís Masmiquel 1
1Department of Endocrinology, Hospital Son Llàtzer, Palma de Mallorca, Baleares, Spain; 2Department of Investigation, Hospital Son Llàtzer, Palma de Mallorca, Baleares, Spain.
Introduction: Hepatic metabolism of inhaled corticosteroids (ICS) takes place via cytochrome P450 3A4. Nevertheless, it can be decreased by enzyme inhibitors such as itraconazole or ritonavir, thus leading to an increase in the bioavailability of ICS. This can result in an accumulation of the steroid drug and a cushing’s syndrome.
Case report: We present the case of a 48 year old woman with human immunodeficiency virus (HIV) infection on highly active antiretroviral therapy that included ritonavir.Inhaled fluticasone was added to her treatment of severe chronic asthma. Two years later, she was admitted to the Intensive Care Unit due to a massive upper gastrointestinal bleeding secondary to an erosive gastritis, which required support with vasoactive drugs during 72 h. However, 1 week after her admission, the patient started to present hypoglycemias and hypotension, accompanied by intense astenia and weakness of the inferior limbs. Adrenal insufficiency was suspected. The Physical exam showed a cushingoid appearance. Blood tests were carried out, showing normal renal and liver functions and ions. Her morning serum cortisol concentration was 3.0 μg/dl (5–17 μg/dl) and morning Adrenocorticotropic hormone (ACTH) was 6.7 pg/ml (<46 pg/ml)). A craneal CT was done in order to rule out structural disease (MRI could not be done due to the morbid obesity of the patient) and it was normal. Therefore, final diagnosis was iatrogenic Cushing’s syndrome and acute adrenal insufficiency due to the association of inhaled corticosteroids with ritonavir.
Conclusion: This case emphasizes the need for pharmacovigilance when managing patients on complex drug regimens for physicians treating HIV infected patients.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more