Cushing's Syndrome Due to Pharmacological Interaction in a Cystic Fibrosis Patient
September 2002
in “
Acta pædiatrica
”
Cushing's syndrome iatrogenic itraconazole budesonide striae moon-face increased facial hair growth mood swings headaches weight gain irregular menstruation increased insulin requirement plasma cortisol adrenocorticotropin cytochrome P450 enzymes CYP3A isoforms adrenal insufficiency Cushing's syndrome moon-face increased facial hair growth mood swings headaches weight gain irregular menstruation increased insulin requirement adrenal insufficiency
TLDR A cystic fibrosis patient developed Cushing's syndrome from a drug interaction between itraconazole and budesonide, which improved after stopping the medications.
The document reported a case of a cystic fibrosis patient who developed iatrogenic Cushing's syndrome due to the pharmacological interaction between itraconazole and budesonide. The patient was on long-term treatment with 800 mg of itraconazole and 1600 μg of budesonide daily, leading to symptoms such as striae, moon-face, increased facial hair growth, mood swings, headaches, weight gain, irregular menstruation, and increased insulin requirement. Endocrine investigations showed total suppression of plasma cortisol and adrenocorticotropin. Discontinuation of both drugs resulted in symptom improvement and recovery of the pituitary-adrenal axis after 3 months. The study concluded that itraconazole inhibited the metabolic clearance of budesonide by affecting cytochrome P450 enzymes, particularly CYP3A isoforms, leading to elevated systemic budesonide levels and suppression of adrenal function. It recommended regular monitoring for adrenal insufficiency in patients receiving this combination therapy.
