Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency Due to an Interaction Between Fluticasone and Ritonavir
May 2021
in “
Journal of the Endocrine Society
”
iatrogenic Cushing Syndrome secondary adrenal insufficiency fluticasone ritonavir alopecia ACTH cortisol beclomethasone CYP3A4 adrenal suppression Cushing Syndrome adrenal insufficiency Flonase Norvir hair loss adrenocorticotropic hormone steroid hormone Qvar cytochrome P450 3A4 adrenal gland suppression
TLDR A woman developed Cushing syndrome and adrenal insufficiency from using fluticasone and ritonavir together.
The document described a clinical case of a 44-year-old woman with HIV and bronchial asthma who developed iatrogenic Cushing Syndrome and secondary adrenal insufficiency due to an interaction between fluticasone and ritonavir. The patient exhibited symptoms such as increased hair, capillary fragility, alopecia, and muscle atrophy. Laboratory tests confirmed low ACTH and cortisol levels. The treatment involved switching from fluticasone to beclomethasone and adjusting her antiretroviral regimen. The clinical lesson emphasized the risk of using fluticasone with ritonavir due to the inhibition of CYP3A4, leading to elevated fluticasone levels and adrenal suppression. It recommended avoiding fluticasone in patients on ritonavir and suggested alternative treatments. Most cases resolved within 9-12 months.
