Hypercortisolism caused by ritonavir associated inhibition of CYP 3A4 under inhalative glucocorticoid therapy. 2 case reports and a review of the literature

Exp Clin Endocrinol Diabetes. 2012 Mar;120(3):125-7. doi: 10.1055/s-0031-1297993. Epub 2012 Feb 10.

Abstract

Recent in vitro and in vivo studies have shown a potent inhibition of cytochrome P450 CYP3A4 through human immune deficiency virus (HIV) protease inhibitors (PIs). The PI ritonavir is described as the most potent compound within these CYP3A4 inhibitors. We present 2 cases who developed the sequelae of glucocorticoid excess following ritonavir therapy and inhalative glucocorticoid treatment: A 60-year-old HIV positive man developed the typical symptoms of Cushing's syndrome and a 52-year-old HIV positive man developed severe osteoporosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Inhalation
  • Cushing Syndrome / chemically induced*
  • Cushing Syndrome / diagnosis
  • Cytochrome P-450 CYP3A
  • Cytochrome P-450 CYP3A Inhibitors*
  • Enzyme Inhibitors / pharmacology
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects*
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / metabolism
  • HIV Protease Inhibitors / administration & dosage
  • HIV Protease Inhibitors / adverse effects
  • HIV Protease Inhibitors / pharmacology
  • HIV-1 / physiology
  • Humans
  • Male
  • Middle Aged
  • Polypharmacy
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Ritonavir / administration & dosage
  • Ritonavir / adverse effects*
  • Ritonavir / pharmacology*

Substances

  • Cytochrome P-450 CYP3A Inhibitors
  • Enzyme Inhibitors
  • Glucocorticoids
  • HIV Protease Inhibitors
  • Cytochrome P-450 CYP3A
  • CYP3A4 protein, human
  • Ritonavir