title: [Exogenous Cushing's syndrome as a serious side-effect of therapy with ritonavir an inhaled fluticasone].
abstract: Inhalation of fluticasone is usually devoid of systemic side-effects. The authors describe a case of a young HIV positive woman treated concomitantly with fluticasone and inhibitors of HIV protease ritonavir and lopinavir in which developed a serious endocrine side-effect - an iatrogenic Cushing's syndrome. Plasma concentration of cortisol < 5.5 nmol/l was very low (norm 250-650 nmol/l) and plasmatic ACTH was even not detectable. The administration of fluticasone and both inhibitors of HIV protease was stopped and substitution therapy with decreasing dose of hydrocortisone was initiated. Twenty weeks later resolved both clinical and laboratory symptoms of Cushing's syndrome, and the substitution therapy with hydrocortisone was terminated. Two years later became the patient pregnant and gave birth to a healthy child.
authors.affiliation: Clinic of Infectious Diseases, 3rd Medical Faculty, University Hospital Bulovka Prague, Czech Republic. ladimachala@centrum.cz
authors.forename: Ladislav
authors.initials: L
authors.lastname: Machala
authors.forename: Alexander
authors.initials: A
authors.lastname: Kréze
authors.forename: David
authors.initials: D
authors.lastname: Jilich
authors.forename: Hanuš
authors.initials: H
authors.lastname: Rozsypal
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects*; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D000068298:Fluticasone; D015658:HIV Infections / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D019438:Ritonavir / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000730:Androstadienes; D018926:Anti-Allergic Agents; D017320:HIV Protease Inhibitors; D000068298:Fluticasone; D019438:Ritonavir