{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T13:03:07Z","timestamp":1788613387658,"version":"build-2803163510"},"reference-count":17,"publisher":"The Endocrine Society","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Ritonavir, a protease inhibitor (PI), is a potent inhibitor of cytochrome P450 3A4. This pharmacological effect, even at low doses (\u2264200 mg\/d), is used to \u201cboost\u201d levels of other PIs in the treatment of HIV infection and facilitate once or twice daily dosing with reduced pill burden. Six patients with preexisting HIV-lipodystrophy developed symptomatic Cushing\u2019s syndrome when treated with inhaled fluticasone at varying doses for asthma while concurrently treated with low-dose ritonavir-boosted PI antiretroviral therapy (ART) regimens for HIV infection. There was evidence of adrenal suppression in all patients on stimulation studies. After the withdrawal of inhaled fluticasone, four patients became symptomatic of hypocortisolism, and three required oral corticosteroid support for several months. Other complications included evidence of osteoporosis (n = 3), crush fractures (n = 1), and exacerbation of preexisting type 2 diabetes mellitus (n = 1). In part, the diagnosis of fluticasone-induced Cushing\u2019s syndrome was delayed because all patients had preexisting body composition changes of ART-associated lipodystrophy, masking the Cushing\u2019s features. Practitioners should be aware of the impact on the adrenal axis of coadministration of PI-based ART regimens with inhaled corticosteroids and the potential for exacerbating or even inducing other metabolic conditions, such as osteoporosis or diabetes.<\/jats:p>","DOI":"10.1210\/jc.2005-0036","type":"journal-article","created":{"date-parts":[[2005,7,7]],"date-time":"2005-07-07T06:50:02Z","timestamp":1120719002000},"page":"4394-4398","source":"Crossref","is-referenced-by-count":110,"title":["Iatrogenic Cushing\u2019s Syndrome with Osteoporosis and Secondary Adrenal Failure in Human Immunodeficiency Virus-Infected Patients Receiving Inhaled Corticosteroids and Ritonavir-Boosted Protease Inhibitors: Six Cases"],"prefix":"10.1210","volume":"90","author":[{"given":"Katherine","family":"Samaras","sequence":"first","affiliation":[{"name":"Department of Endocrinology (K.S.), St. Vincent\u2019s Hospital and St. Vincent\u2019s Clinic 2010, New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Pett","sequence":"additional","affiliation":[{"name":"Immunology and Infectious Diseases Unit (S.P., D.A.C.) 2010, New South Wales Australia"},{"name":"Immunology and Infectious Diseases Unit (S.P., D.A.C.) 2010, New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Gowers","sequence":"additional","affiliation":[{"name":"Holdsworth House General Practice (A.G.), Darlinghurst, New South Wales 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"McMurchie","sequence":"additional","affiliation":[{"name":"407 Doctors General Practice (M.M.), Surry Hills, New South Wales 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Immunology and Infectious Diseases Unit (S.P., D.A.C.) 2010, New South Wales Australia"},{"name":"St. Vincent\u2019s Hospital; National Centre for HIV Epidemiology and Clinical Research (S.P., D.A.C.), University of New South Wales 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"issue":"Pt 2","key":"2020071617472718800_R1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.7326\/0003-4819-137-5_Part_2-200209031-00001","article-title":"Guidelines for using antiretroviral agents among HIV-infected adults and adolescents","volume":"137","author":"Dybul","year":"2002","journal-title":"Ann Intern Med"},{"key":"2020071617472718800_R2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/jac\/dkh029","article-title":"Pharmacological and therapeutic properties of ritonavir-boosted protease inhibitor therapy in HIV-infected patients.","volume":"53","author":"Zeldin","year":"2004","journal-title":"Antimicrob Chemother"},{"key":"2020071617472718800_R3","first-page":"1","article-title":"National Asthma Education and Prevention Program. 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