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Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients
Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic–pituitary–adrenal suppressio...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192878/ https://www.ncbi.nlm.nih.gov/pubmed/32140912 http://dx.doi.org/10.1007/s11096-020-00995-5 |
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author | Besemer, Femke Kramers, Cornelis Brinkman, Kees Hermus, Ad R. M. M. van Herwaarden, Antonius E. Burger, David M. |
author_facet | Besemer, Femke Kramers, Cornelis Brinkman, Kees Hermus, Ad R. M. M. van Herwaarden, Antonius E. Burger, David M. |
author_sort | Besemer, Femke |
collection | PubMed |
description | Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic–pituitary–adrenal suppression by local corticosteroids in HIV-infected patients. Method Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic–pituitary–adrenal axis was defined as a morning plasma cortisol below 80 nmol/L or a cortisol below 550 nmol/L during a 250 mcg adrenocorticotropic hormone-stimulation test. Results Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamic–pituitary–adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. Conclusion Hypothalamic–pituitary–adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4. ClinicalTrials.gov Identifier NCT02501486. |
format | Online Article Text |
id | pubmed-7192878 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-71928782020-05-05 Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients Besemer, Femke Kramers, Cornelis Brinkman, Kees Hermus, Ad R. M. M. van Herwaarden, Antonius E. Burger, David M. Int J Clin Pharm Short Research Report Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic–pituitary–adrenal suppression by local corticosteroids in HIV-infected patients. Method Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic–pituitary–adrenal axis was defined as a morning plasma cortisol below 80 nmol/L or a cortisol below 550 nmol/L during a 250 mcg adrenocorticotropic hormone-stimulation test. Results Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamic–pituitary–adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. Conclusion Hypothalamic–pituitary–adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4. ClinicalTrials.gov Identifier NCT02501486. Springer International Publishing 2020-03-05 2020 /pmc/articles/PMC7192878/ /pubmed/32140912 http://dx.doi.org/10.1007/s11096-020-00995-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Short Research Report Besemer, Femke Kramers, Cornelis Brinkman, Kees Hermus, Ad R. M. M. van Herwaarden, Antonius E. Burger, David M. Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title | Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title_full | Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title_fullStr | Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title_full_unstemmed | Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title_short | Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients |
title_sort | hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in hiv-infected patients |
topic | Short Research Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192878/ https://www.ncbi.nlm.nih.gov/pubmed/32140912 http://dx.doi.org/10.1007/s11096-020-00995-5 |
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