Methods: We present the clinical and biochemical data of two patients in whom diagnosis of Cushing syndrome was caused by this interaction. We also reviewed the pertinent literature and management options.
Results: A 71-year-old man was treated with inhaled budesonide for a BLZ945 chronic obstructive pulmonary disease and itraconazole for a pulmonary aspergillosis. The patient rapidly developed a typical Cushing syndrome complicated by bilateral avascular necrosis of the femoral heads. Serum 8: 00 AM cortisol concentrations were suppressed at 0.76 and 0.83 mu g/dL on two occasions. The patient died 4 days
later of a massive myocardial infarction. The second case is a 46-year-old woman who was treated for several years with inhaled budesonide for asthma. She was put on ritonavir, a retroviral protease inhibitor, for the treatment of human immunodeficiency virus (HIV). In the following months, she developed typical signs of Cushing syndrome. Her morning serum cortisol concentration was 1.92 mu g/ dL. A cosyntropin stimulation test showed Sapanisertib in vivo values of serum cortisol of <1.10, 2.65, and 5.36 mu g/dL at 0, 30, and 60 minutes, respectively, confirming
an adrenal insufficiency. Because the patient was unable to stop budesonide, she was advised to reduce the frequency of its administration and eventually taper the dose until cessation.
Conclusion: Clinicians should be aware of the potential occurrence of iatrogenic Cushing syndrome and secondary
adrenal insufficiency due to the association of inhaled corticosteroids with itraconazole or ritonavir.”
“Purpose of reviewTo update information about pediatric thyroid cancer.Recent findingsThis review of thyroid nodules in children indicates that the incidence of thyroid cancer has been steadily increasing over the last 30 years. Knowledge of factors which predispose to the development of thyroid cancer – radiation exposure and family history of thyroid cancer or personal or family history of familial syndromes associated with thyroid cancer – can help determine Selleck MK-2206 the aggressiveness with which the diagnostic studies of thyroid nodules should be pursued. Presence of thyroid nodules should prompt measurement of circulating thyroid-stimulating hormone. Thyroid nodules should generally be studied with thyroid ultrasonography; those greater than 0.5-1cm in diameter which are not simple cysts should be studied with fine-needle aspiration (FNA). When cytologic analysis is indeterminate, a number of molecular techniques may assist in determining which patients should undergo thyroid surgery.SummaryThe relative frequency of indeterminate cytology on FNA could necessitate surgery in a large number of patients who will be found to have benign lesions.