{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:31Z","timestamp":1784557051649,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,4,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    We present a case of iatrogenic Cushing\u2019s syndrome, induced by treatment with fluticasone furoate (1\u20132\u2009dd, 27.5\u2009\u00b5g in each nostril) in a pediatric patient treated for congenital HIV. The pediatric patient described in this case report is a young girl of African descent, treated for congenital HIV with a combination therapy of Lopinavir\/Ritonavir (1\u2009dd 320\/80\u2009mg), Lamivudine (1\u2009dd 160\u2009mg) and Abacavir (1\u2009dd 320\u2009mg). Our pediatric patient presented with typical Cushingoid features (i.e. striae of the upper legs, full moon face, increased body and facial hair) within weeks after starting fluticasone furoate therapy, which was exacerbated after increasing the dose to 2\u2009dd because of complaints of unresolved rhinitis. Biochemical analysis fitted iatrogenic Cushing\u2019s syndrome, with a repeatedly low cortisol (&lt;0.03\u2009\u00b5M, ref 0.14\u20130.60\u2009\u00b5M) and low ACTH (9\u2009pg\/mL, ref 9\u201352\u2009pg\/mL) without signs of adrenal insufficiency. No other biochemical abnormalities that could point to adrenal or pituitary dysfunction were detected; electrolytes, thyroid and gonadal function, and IGF-1 were within the normal range. Pharmacogenetic analysis revealed that the pediatric patient carried the\n                    <jats:italic>CYP3A4 *1B\/*1G<\/jats:italic>\n                    and\n                    <jats:italic>CYP3A5 *3\/*3<\/jats:italic>\n                    genotype (associated with a partial and complete loss of enzyme activity, respectively) which is associated with the development of iatrogenic Cushing\u2019s syndrome in patients treated for HIV due to the strong inhibition of CYP3 enzymes by Ritonavir. Upon discontinuation of fluticasone treatment, the pediatric patient improved both clinically and biochemically with normalisation of cortisol and ACTH within a couple of weeks.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Fluticasone therapy may induce iatrogenic Cushing\u2019s syndrome in a patient treated with anti-retroviral therapy.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pharmacogenetic analysis, in particular CYP3A genotyping, provides useful information in patients treated for HIV with respect to possible future steroid treatment.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Fluticasone furoate is not detected in the Siemens Immulite cortisol binding assay.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-16-0158","type":"journal-article","created":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T06:15:58Z","timestamp":1491459358000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Fluticasone furoate induced iatrogenic Cushing syndrome in a pediatric patient receiving anti-retroviral therapy"],"prefix":"10.1530","volume":"2017","author":[{"given":"S A A","family":"van den Berg","sequence":"first","affiliation":[{"name":"1Laboratory for Clinical Chemistry and Haematology, Amphia Hospital, Breda The Netherlands"},{"name":"2Laboratory for Clinical Chemistry, Erasmus MC, Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N E","family":"van \u2018t Veer","sequence":"additional","affiliation":[{"name":"3Departments of Clinical Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M A","family":"Emmen","sequence":"additional","affiliation":[{"name":"1Laboratory for Clinical Chemistry and Haematology, Amphia Hospital, Breda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R H T","family":"van Beek","sequence":"additional","affiliation":[{"name":"4Departments of Pediatrics, Amphia Hospital, Breda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"key20170421170319032_bib1","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1111\/j.1398-9995.2008.01750.x","article-title":"Molecular and clinical pharmacology of intranasal corticosteroids: Clinical and therapeutic implications","volume":"63","author":"Derendorf","year":"2008","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"key20170421170319032_bib2","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/j.1399-3038.2008.00775.x","article-title":"HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis","volume":"20","author":"Tripathy","year":"2009","journal-title":"Pediatric Allergy and Immunology"},{"key":"key20170421170319032_bib3","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/j.1742-7843.2006.pto_249.x","article-title":"Differential inhibition of cytochrome P450 3A4, 3A5 and 3A7 by five human immunodeficiency virus (HIV) protease inhibitors in vitro","volume":"98","author":"Granfors","year":"2006","journal-title":"Basic and Clinical Pharmacology and Toxicology"},{"key":"key20170421170319032_bib4","doi-asserted-by":"publisher","first-page":"860","DOI":"10.3109\/02770903.2011.606580","article-title":"Inhaled fluticasone causes iatrogenic Cushing\u2019s syndrome in patients treated with Ritonavir","volume":"48","author":"Mahlab-Guri","year":"2011","journal-title":"Journal of Asthma"},{"key":"key20170421170319032_bib5","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/S0889-8529(02)00008-7","article-title":"Glucocorticoid withdrawal schemes in chronic medical disorders. 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