Iatrogenic Cushing’s syndrome and Secondary Adrenal Insufficiency in an HIV Patientreceiving Fluticasone and Ritonavir
  • Imro Vlasveld
    Dept. of Internal Medicine, Haga Teaching Hospital, The Hague
  • Maarten O. van Aken
    Dept. of Internal Medicine, Haga Teaching Hospital, The Hague
  • Cees Van Nieuwkoop
    Dept. of Internal Medicine, Haga Teaching Hospital, The Hague

Abstract

Objectives: To illustrate that the protease inhibitor (PI) ritonavir, widely used as part of the treatment for HIV, might cause drug–drug interactions with inhaled corticosteroids.

Material and methods: A case report is presented.

Results: An HIV-positive patient presented with gradually changing body composition that was ascribed to lipodystrophy. Finally, iatrogenic Cushing's syndrome with secondary adrenal insufficiency was diagnosed due to a drug–drug interaction of ritonavir and fluticasone.

Conclusion: Lipodystrophy might mimic Cushing's syndrome. The combination of ritonavir and inhaled fluticasone may lead to systemic steroid excess causing Cushing's syndrome and secondary adrenal insufficiency.

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References

  • Abbott Laboratories. Norvir (ritonavir) package insert. North Chicago, IL, 2006.
  • Samaras K, Pett S, Gowers A, McMurchie M, Cooper DA. Iatrogenic Cushing's syndrome with osteoporosis and secondary adrenal failure in human immunodeficiency virus-infected patients receiving inhaled corticosteroids and ritonavir-boosted protease inhibitors: six cases, J Clin Endocrinol Metab 2005;41:793–795.
  • Gupta SK, Dube MP. Exogenous Cushing's syndrome mimicking human immunodeficiency virus lipodystrophy, Clin Infect Dis 2002;35 :E69–71.
  • Foisy MM, Yakiwchuk EMK, Chiu I, Sing AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature, HIV Med 2008;9:389–396.
  • Woods DR, Arun CS, Corris PA, Perros P. Cushing's syndrome without excess cortisol, BMJ 2006;332:469–470.

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    Published: 2014-04-07
    Issue: Vol. 1 (2014) (view)

    How to cite:
    1.
    Vlasveld I, O. van Aken M, Van Nieuwkoop C. Iatrogenic Cushing’s syndrome and Secondary Adrenal Insufficiency in an HIV Patientreceiving Fluticasone and Ritonavir. EJCRIM 2014;1 doi:10.12890/2014_000043.