Rapidly developing Cushing syndrome in a 4-year-old patient during combined treatment with itraconazole and inhaled budesonide.
A 4-year-old boy with cystic fibrosis developed hypertension, rapid weight gain and a moon face 2 weeks after starting a combined treatment of oral itraconazole and inhaled budesonide for a suspected allergic bronchopulmonary aspergillosis. Adrenal suppression was documented and found to persist 3 months after stopping this combined treatment.


CONCLUSIONS
To the best of our knowledge, this is the first time that an iatrogenic Cushing syndrome in a young child with cystic fibrosis after such combined treatment is reported. The inhibition of cytochrome P4503A by intraconazole and a higher glucocorticoid tissue sensitivity is suggested as the underlying mechanism.
Department of Paediatric Respiratory Medicine and Cystic Fibrosis Clinic, Vrije Universiteit Brussel, Brussels, Belgium.
Elke
E
De Wachter
Paediatric Endocrinology Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 , Brussels, Belgium.
Jesse
J
Vanbesien
Department of Paediatric Respiratory Medicine and Cystic Fibrosis Clinic, Vrije Universiteit Brussel, Brussels, Belgium.
Iris
I
De Schutter
Department of Paediatric Respiratory Medicine and Cystic Fibrosis Clinic, Vrije Universiteit Brussel, Brussels, Belgium.
Anne
A
Malfroot
Paediatric Endocrinology Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 , Brussels, Belgium. jean.deschepper@az.vub.ac.be.
Jean
J
De Schepper
D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy / Q000453:epidemiology; D019819:Budesonide / Q000009:adverse effects*; D002675:Child, Preschool; D015897:Comorbidity; D003480:Cushing Syndrome / Q000139:chemically induced*; D003550:Cystic Fibrosis / Q000453:epidemiology; D004359:Drug Therapy, Combination; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects*; D008297:Male; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D017964:Itraconazole; D019819:Budesonide