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].