Iatrogenic Cushing's Syndrome in a Small Case Series of HIV Patients on Steroid Inhalation and Antiretroviral Therapies

Abstract

Cushing's syndrome is uncommon in patients on therapeutic doses of inhaled steroids. We studied 2 cases of human immunodeficiency virus (HIV) infection who had a rapid onset of Cushing's syndrome secondary to fluticasone propionate interacting with their antiretroviral therapy. Case 1 is a 27-year-old woman with a history of drug addiction problems, anxiety disorder, progressive multifocal leukoencephalopathy and asthma. She presented to the emergency room following a 3-week history of frequent fluticasone inhalation for anxiety type symptoms. Her medications included Prezista, Norvir (ritonavir), fluticasone and Bactrim. Clinical findings were abdominal obesity and extensive purple striae. Laboratory results showed normal midnight salivary cortisol, low 24-hour urinary free cortisol and normal overnight dexamethasone suppression of morning cortisol. Case 2 is a 38-year-old woman with history of rapid 50-pound weight gain and painful purple striae associated with fluticasone inhaler abuse for anxiety symptoms. Other medical problems were drug addiction problems, anxiety and asthma. Her medications were Fluoxetine, Olanzapine, Montelukast, Prezista, Norvir, Truvuda, salbutamol inhaler and ranitidine. Laboratory results showed a low 24-hour urinary free cortisol and undetectable plasma adrenocorticotropic hormone (ACTH).