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 mood swings headaches weight gain irregular menstruation increased insulin requirement plasma cortisol adrenocorticotropin cytochrome P450 enzymes CYP3A isoforms adrenal suppression adrenal insufficiency Cushing's syndrome moon-face increased facial hair mood swings headaches weight gain irregular menstruation increased insulin requirement adrenal suppression adrenal insufficiency
TLDR A cystic fibrosis patient developed Cushing's syndrome from a drug interaction between itraconazole and inhaled budesonide.
A cystic fibrosis patient developed iatrogenic Cushing's syndrome after long-term treatment with itraconazole (800 mg daily) and budesonide (1600 μg daily). Symptoms included striae, moon-face, increased facial hair, mood swings, headaches, weight gain, irregular menstruation, and increased insulin requirement. Endocrine tests showed total suppression of plasma cortisol and adrenocorticotropin. Discontinuing both drugs improved symptoms and restored pituitary-adrenal function 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 adrenal suppression. Regular monitoring for adrenal insufficiency is recommended for patients on this combination therapy.
