Elke De Wachter1, Jesse Vanbesien2, Iris De Schutter1, Anne Malfroot1, Jean De Schepper3. 1. Department of Paediatric Respiratory Medicine and Cystic Fibrosis Clinic, Vrije Universiteit Brussel, Brussels, Belgium. 2. Paediatric Endocrinology Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 , Brussels, Belgium. 3. Paediatric Endocrinology Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 , Brussels, Belgium. jean.deschepper@az.vub.ac.be.
Abstract
UNLABELLED: 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.
UNLABELLED: 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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