DOI: 10.12890/2014_000043
Iatrogenic Cushing’s syndrome and Secondary Adrenal Insufficiency in an HIV Patientreceiving Fluticasone and Ritonavir
Authors
imrov@hotmail.com
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.
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.