Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review

Table 1

Assessment of the patient’s adrenal axis at various time points following triamcinolone injection.

	Four weeks and 2 days after injection	Five weeks and 3 days after injection	Nine weeks and 2 days after injection	Fourteen weeks after injection and about 3 weeks after change in ART regimen
Cortisol 0 min; (mcg/dL)	—	3.4	4.3	—
Cortisol 15 min following administration of cosyntropin); (mcg/dL)	—	8.0	—	—
Cortisol 30 min following administration of cosyntropin; (mcg/dL)	—	13	21	—
Cortisol 45 min following administration of cosyntropin; (mcg/dL)	—	14	—	—
Cortisol 60 min following administration of cosyntropin; (mcg/dL)	—	—	26	—
Urine synthetic glucocorticoid screen	Triamcinolone 0.61 mcg/dL (range <0.10)	—	Negative	—
24 h urine cortisol	—	—	—	12 mcg/24 hours (range 3.5–45)

The criterion for expected serum cortisol on the standard high dose ACTH stimulation test is a minimum value 18 to 20 mcg/dL before or after ACTH injection [1].