I saw
a patient yesterday who was referred as ?Cushings syndrome via confuse &
block (so not from a practice that would usually refer here). He is HIV+ve and
has been on a range of the usual drugs for at least the last 3 years. He also
has asthma and has used fluticasone inhalers for many years. He had the most
impressive abdominal striae I have ever seen (less than 50% of his abdominal
skin was unaffected). The HIV clinic [at another hospital, not ours], had sent
him to a neurologist because of proximal limb weakness, and neurology had
advised an endocriniology referral. They did a 24 hr urine free cortisol (result
less than lower standard, so technically undetectable) and the random cortisol
done yesterday was 19.
It turned out that Ritanavir is an extremely potent inhibitor of steroid metabolism (lots of reports in the
literature), and patients on this have developed striae and adrenal suppression from remarkably
low doses of steroid. One case I found had only had one intra-articular injection of triamcinolone.
Therefore, it is probably pointless measuring triamcinolone levels; it would
make more sense to monitor cortisol or UFC to identify whether adrenal
suppression is setting in.
TIM
**************************************************************************************
Prof. Tim
Reynolds
Consultant Chemical Pathologist / Associate Clinical Director -
Diagnostics / R&D Lead,
Burton Hospitals NHS Foundation
Trust
work tel: 01283 511511 ext 4035
work fax: 01283
593064
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A HIV pharmacist has expressed an interest in monitoring
triamcinolone (trade name kenalog) levels in a patient also receiving protease
inhibitors.
Do any mailbase users have a method for measuring this
steroid in serum/plasma?
Thanks,
Oliver Clifford-Mobley
Department of Clinical
Biochemistry
Royal Free Hampstead NHS
Trust
Phone: 020 7794 0500 ext.
38856
Fax: 020 7830
2235
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