title: Ritonavir and Topical Ocular Corticosteroid Induced Cushing's Syndrome in an Adolescent With HIV-1 Infection.
abstract: Cushing's syndrome after topical ocular corticosteroid use is extremely rare. We describe a case of symptomatic Cushing's syndrome in an adolescent male with sight-threatening vernal keratoconjunctivitis on antiretroviral therapy for HIV-1 infection that included ritonavir, a potent cytochrome p450 CYP3A4 inhibitor. CYP3A4 inhibition reduces the metabolism of exogenous corticosteroids leading to suppression of endogenous steroid production and Cushing's syndrome.
authors.affiliation: From the *University Hospital Southampton, Southampton, Hampshire, United Kingdom; †NHS Foundation Trust, United Kingdom; ‡Imperial College London, Kensington, London, United Kingdom; §Portsmouth Hospitals, Portsmouth, United Kingdom; and ¶Poole Hospitals, Poole, United Kingdom.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Rainsbury
authors.forename: Jessica
authors.initials: J
authors.lastname: Sharp
authors.forename: Alison
authors.initials: A
authors.lastname: Tappin
authors.forename: Martin
authors.initials: M
authors.lastname: Hussey
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lenko
authors.forename: Caroline
authors.initials: C
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000188:drug therapy*; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000473:pathology; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D004347:Drug Interactions; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D017320:HIV Protease Inhibitors; D019438:Ritonavir