Tripathi Kartikeya, Dunzendorfer Thomas
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD.
Department of Gastroenterology, Berkshire Medical Center, Pittsfield, MA.
ACG Case Rep J. 2017 Jan 4;4:e5. doi: 10.14309/crj.2017.5. eCollection 2017.
Budesonide is the treatment of choice for microscopic colitis because of its excellent risk to benefit ratio. It is a potent, well-absorbed corticosteroid, but because of a high rate of first-pass metabolism in the liver, its systemic bioavailability is low. It has fewer corticosteroid-related adverse effects than prednisone, and adrenal suppression is considered to be rare. We present a middle-aged woman with lymphocytic colitis whose symptoms responded to budesonide but developed budesonide-related iatrogenic Cushing's syndrome. Withdrawal of budesonide led to restoration of normal pituitary-adrenal responsiveness but at the price of recurrent diarrhea due to re-emergence of lymphocytic colitis.
由于布地奈德具有出色的风险效益比，它是显微镜下结肠炎的首选治疗药物。它是一种强效且吸收良好的皮质类固醇，但由于在肝脏中的首过代谢率高，其全身生物利用度较低。与泼尼松相比，它与皮质类固醇相关的不良反应较少，且肾上腺抑制被认为很少见。我们报告了一名患有淋巴细胞性结肠炎的中年女性，其症状对布地奈德有反应，但却出现了与布地奈德相关的医源性库欣综合征。停用布地奈德导致垂体 - 肾上腺反应恢复正常，但代价是由于淋巴细胞性结肠炎复发而再次出现腹泻。
