Endocrine Abstracts

Introduction: Cushing’s Syndrome secondary to inhaled or topic corticosteroids is very rare, although there are reports of a link to cytochrome inhibitors. Ritonavir, a protease inhibitor used for treatment in human immunodeficiency virus (HIV) infection, is a potent inhibitor of cytochrome P450 3A4.

The case: A 41 years old man - with personal history of asthma, HIV infection diagnosed in 2002 and hepatitis C infection since 1999 – was sent to an endocrinology consult in January/2015 for obesity investigation and orientation. The patient presents with a one-year history of truncal and facial obesity and global weakness of the lower limbs. Moreover, the patient presented with cushingoid facies, facial plethora, centripetal obesity and hypotrophic upper limbs. At that time, the patient was under therapy with ritonavir 100mg/day, salmeterol/fluticasone 50/250 μg two inhalations per day and a topic betamethasone lotion 0,5mg/g twice a week. Morning total plasma cortisol levels were low (0,6 μg/dl) and ACTH was suppressed (5 pg/ml). Cosyntropin stimulation test confirmed a suppressed pituitary-adrenal axis. Consequently, ritonavir was concluded and the clinical picture resolved progressively.

Conclusion: The present case underlines the importance of cytochrome inhibitors in the modification of corticosteroid metabolism and their extended effect – as in Cushing’s Syndrome.