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Rapidly developing Cushing syndrome in a 4-year-old patient during combined treatment with itraconazole and inhaled budesonide

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Abstract

A 4-year-old boy with cystic fibrosis developed hypertension, rapid weight gain and a moon face 2 weeks after starting a combined treatment of oral itraconazole and inhaled budesonide for a suspected allergic bronchopulmonary aspergillosis. Adrenal suppression was documented and found to persist 3 months after stopping this combined treatment. Conclusion:to the best of our knowledge, this is the first time that an iatrogenic Cushing syndrome in a young child with cystic fibrosis after such combined treatment is reported. The inhibition of cytochrome P4503A by intraconazole and a higher glucocorticoid tissue sensitivity is suggested as the underlying mechanism.

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Abbreviations

ABPA :

allergic bronchopulmonary aspergillosis

CF :

cystic fibrosis

DHEAS :

dehydro-epiandrosterone sulphate

References

  1. Daman Willems CE, Dinwiddie R, Grant DB, Rivers RPA, Zahir M (1994) Temporary inhibition of growth and adrenal suppression associated with the use of steroid nose drops. Eur J Pediatr 153: 632–634

    Article  Google Scholar 

  2. Derijck RH, Schaaf M, de Kloet E (2002) Glucocorticoid receptor variants: clinical implications. J Steroid Biochem Mol Biol 81: 103–122

    Article  Google Scholar 

  3. Hvizdos KM, Jarvis B (2000) Budesonide inhalation suspension. A review of its use in infants, children and adults with inflammatory respiratory disorders. Drugs 60: 1141–1178

    Article  CAS  PubMed  Google Scholar 

  4. Lebrun-Vignes B, Archer VC, Diquet B, Levron JC, Chodisaw O, Puech AJ, Warot D (2001) Effect of itraconazole on the pharmacokinetics of prednisolone and methylprednisolone and cortisol secretion in healthy subjects. Br J Clin Pharmacol 51: 443–450

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Oesterheld JR (1998) A review of developmental aspects of cytochrome P450. J Clin Adolesc Psychopharmacol 8: 161–174

    Article  CAS  Google Scholar 

  6. Panarelli M, Holloway CD, Fraser R, Connell JM, Ingram MC, Anderson NH, Kenyon CJ (1998) Glucocorticoid receptor polymorphism, skin vasoconstriction, and other metabolic intermediate phenotypes in normal human subjects. J Clin Endocrinol Metab 83: 1846–1852

    CAS  PubMed  Google Scholar 

  7. Parmar JS, Howell T, Kelly J, Bilton D (2002) Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis. Thorax 7: 749–750

    Article  Google Scholar 

  8. Perry RJ, Findlay CA, Donaldson MD (2002) Cushing's syndrome, growth impairment, and occult adrenal suppression associated with intranasal steroids. Arch Dis Child 87: 45–48

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Petrus M, Netter JC, Rance F, Chateauneuf R, Bildstein G, Cabalet C, Sermet J, Delprat A (1990) Iatrogenic Cushing syndrome in infants. Ann Pediatr 37: 48–50

    CAS  Google Scholar 

  10. Priftis K, Averard ML, Millner AD (1991) Unexpected side-effects of inhaled steroids. Eur J Pediatr 150: 448–449

    Article  CAS  PubMed  Google Scholar 

  11. Skov M, Main KM, Sillesen IB, Muller J, Koch C, Lanng S (2002) Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. Eur Respir J 20: 127–133

    Article  CAS  PubMed  Google Scholar 

  12. Varis T, Kaukonen KM, Kivistö KT, Neuvonen PJ (1998) Plasma concentrations and effects of oral methylprednisolone are considerably increased by itraconazole. Clin Pharmacol Ther 64: 363–368

    Article  CAS  PubMed  Google Scholar 

  13. Varis T, Kivisto KT, Backman JT, Neuvonen PJ (1999) Itraconazole decreases the clearance and enhances the effects of intravenously administered methylprednisolone in healthy volunteers. Pharmacol Toxicol 85: 29–32

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jean De Schepper.

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De Wachter, E., Vanbesien, J., De Schutter, I. et al. Rapidly developing Cushing syndrome in a 4-year-old patient during combined treatment with itraconazole and inhaled budesonide. Eur J Pediatr 162, 488–489 (2003). https://doi.org/10.1007/s00431-003-1233-8

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  • DOI: https://doi.org/10.1007/s00431-003-1233-8

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