吸入性类固醇联合抗抑郁药物所致医源性库欣综合征

Iatrogenic Cushing's syndrome with inhaled steroid plus antidepressant drugs.

作者信息

Celik Ozlem, Niyazoglu Mutlu, Soylu Hikmet, Kadioglu Pinar

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.

出版信息

Multidiscip Respir Med. 2012 Aug 29;7(1):26. doi: 10.1186/2049-6958-7-26.

DOI:10.1186/2049-6958-7-26

PMID:22958272

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3436715/

Abstract

Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing's syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.

摘要

当前指南推荐使用吸入性糖皮质激素（ICS）来抑制哮喘患者的气道炎症。尽管众所周知ICS会导致剂量相关的肾上腺皮质抑制，但它们可导致医源性库欣综合征（CS）却鲜为人知。丙酸氟替卡松（FP）是一种比倍氯米松和布地奈德更有效的ICS。FP在肝脏和肠道中由细胞色素P450 3A4介导代谢。使用影响细胞色素P450的药物时，FP的全身生物活性会增加。在此，我们报告了一名患者在吸入FP的基础上，接受帕罗西汀和米氮平治疗12周后迅速发生医源性CS。