title: Adrenal Insufficiency as a Result of Ritonavir and Exogenous Steroid Exposure: Report of 6 Cases and Recommendation for Management.
abstract: Numerous cases of Cushing syndrome have been reported as a result of the interaction between ritonavir (RTV) and exogenous steroid medications. Another complication that frequently occurs is secondary adrenal insufficiency, which can be profound and has not been well described. Here, we report 6 cases of adrenal suppression caused by RTV and exogenous steroids, all of which required corticosteroid replacement therapy and 2 of which were severe enough to require hospitalization. These cases add to the body of literature on the dangerous interaction between RTV and corticosteroids and highlight the risk of secondary adrenal suppression. We also review the literature on this complication and make a recommendation for managing and monitoring such cases.
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA bwood2@uw.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wood
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA, USA.
authors.forename: John Matthew
authors.initials: JM
authors.lastname: Lacy
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Johnston
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Weigle
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
authors.forename: Shireesha
authors.initials: S
authors.lastname: Dhanireddy
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy / Q000821:virology*; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019438:Ritonavir / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D017320:HIV Protease Inhibitors; D019438:Ritonavir
keywords: Cushing syndrome; HIV; adrenal insufficiency; glucocorticoids; ritonavir