Song Yu, Schroeder Jonathan R, Bush Larry M
J Int Assoc Provid AIDS Care. 2014 Nov-Dec;13(6):511-4.
Triamcinolone is a long-acting glucocorticoid medication that can be responsible for transient suppression of the hypothalamic–pituitary–adrenal (HPA) axis. This physiologic alteration may persist for weeks after repeated or even single localized injection of this agent. However, when this glucocorticoid agent is given to patients receiving the HIV protease inhibitor (PI) ritonavir (RTV),inhibition of their shared cytochrome P450 3A4 degradation pathway leads to an increased bioavailability of triamcinolone, with subsequent heightening and prolongation of the glucocorticoid serum levels. In those instances, iatrogenic Cushing syndrome may ensue. The authors encountered such an event in an HIV-infected patient on chronic treatment with an antiretroviral regimen containing RTV. The patient's clinical presentation and laboratory investigations confirmed a diagnosis of Cushing syndrome and secondary adrenal insufficiency. This was believed to have occurred in close association following cervical vertebral column facet joint injections with triamcinolone acetonide for cephalagia deemed related to cervical spine disease. The discontinuation of the RTV-boosted PI therapy alone, promoting the clearance of the elevated triamcinolone serum levels and restoration of HPAhomeostasis, proved successful in this patient. For this case, the authors review the published English medical literature relating to this uncommon phenomenon.
曲安奈德是一种长效糖皮质激素药物，可导致下丘脑 - 垂体 - 肾上腺（HPA）轴的短暂抑制。这种生理改变在反复甚至单次局部注射该药物后可能会持续数周。然而，当这种糖皮质激素药物给予接受HIV蛋白酶抑制剂（PI）利托那韦（RTV）的患者时，它们共同的细胞色素P450 3A4降解途径受到抑制，导致曲安奈德的生物利用度增加，随后糖皮质激素血清水平升高并延长。在这些情况下，可能会发生医源性库欣综合征。作者在一名接受含RTV的抗逆转录病毒方案长期治疗的HIV感染患者中遇到了这样的事件。患者的临床表现和实验室检查证实了库欣综合征和继发性肾上腺功能不全的诊断。这被认为与用曲安奈德醋酸酯进行颈椎小关节注射治疗被认为与颈椎病相关的头痛密切相关。仅停用RTV增强的PI治疗，促进升高的曲安奈德血清水平的清除和HPA稳态的恢复，在该患者中被证明是成功的。针对该病例，作者回顾了已发表的与这种罕见现象相关的英文医学文献。
