Cushing's syndrome with adrenal suppression induced by inhaled budesonide due to a ritonavir drug interaction in a woman with HIV infection

Int J STD AIDS. 2012 Jul;23(7):520-1. doi: 10.1258/ijsa.2011.011408.

Abstract

A 48-year-old woman with HIV infection developed Cushingoid features while she was taking ritonavir-boosted darunavir. Cushing's syndrome was confirmed due to the drug interaction between ritonavir and budesonide. Diagnosis of iatrogenic Cushing's syndrome in HIV-positive patients who are on ritonavir-boosted protease inhibitors (PIs) presents a clinical challenge due to similar clinical features of lipohypertrophy related to ritonavir-boosted PIs. Although this complication has been widely described with the use of inhaled fluticasone, the interaction with inhaled budesonide at therapeutic dose is not widely recognized.

Publication types

  • Case Reports

MeSH terms

  • Administration, Inhalation
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Budesonide / administration & dosage
  • Budesonide / adverse effects*
  • Cushing Syndrome / chemically induced*
  • Cushing Syndrome / complications
  • Drug Interactions
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Hypothalamo-Hypophyseal System / drug effects
  • Hypothalamo-Hypophyseal System / physiopathology
  • Middle Aged
  • Pituitary-Adrenal System / drug effects
  • Pituitary-Adrenal System / physiopathology
  • Ritonavir / administration & dosage
  • Ritonavir / adverse effects*
  • Ritonavir / therapeutic use

Substances

  • Anti-HIV Agents
  • Budesonide
  • Ritonavir