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5 results

  • Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature

  • N Seymour, M Robinson, D Richardson, H Mohammed, D Williams, J A McGilligan
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 9 / September 2021
    Published online by Cambridge University Press:
    13 August 2021, pp. 755-758
    Print publication:
    September 2021
  • Background

    There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome.

    Method

    All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.

    Results

    A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.

    Conclusion

    The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

  • 18 - Endocrine disorders

  • from Part III - Working with specific units
  • Edited by Geoffrey Lloyd, Priory Hospital, London, Elspeth Guthrie, University of Manchester
  • Book:
    Handbook of Liaison Psychiatry
    Published online:
    10 December 2009
    Print publication:
    24 May 2007, pp 432-453

  • Summary

    This chapter reviews available data in relation to the characteristics and frequency of specific psychiatric syndromes in primary endocrine disturbances. Hypocalcaemia is considered to be the fundamental cause of the psychological symptoms. In asymptomatic patients with calcium levels at the lower limit of normal (partial parathyroid insufficiency), anxiety, depression and related symptoms may be episodic, precipitated by calcium deprivation. A double-blind trial of calcium vs. placebo in these patients was effective in reducing symptomatology. Hyperprolactinaemia is a frequent disturbance in clinical endocrinology, mostly due to prolactinomas in women. Psychiatric presentations in Cushing's syndrome are well substantiated. Depression has been documented in most studies, and clinical experience suggests that its assessment may be critical. Acromegaly, the disease due to overproduction of pituitary growth hormone, has been associated with psychiatric manifestations, but the existing documentation is limited and recent studies suggest lower rates of psychiatric morbidity.

  • 13 - Hypertension and stroke

  • from Part III - Disease prevention
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University
  • Book:
    Women's Health in Mid-Life
    Published online:
    21 August 2009
    Print publication:
    25 March 2004, pp 225-234

  • Summary

    There are various types of essential hypertension, as there is a variety of genetic patterns, including no patterns. The causes of hypertension include alcohol abuse, renal vascular and parenchymal disease, and certain endocrine states, including pheochromocytoma, Cushing's syndrome, and primary aldosteronism. The primary treatment of hypertension definitely starts with lifestyle changes, especially in individuals with borderline hypertension. Concomitant diseases can make high blood pressure difficult to control. Strokes are one of the most important causes of disability and the second most common cause of death worldwide. Primary prevention focuses on reducing risk factors for stroke. The six most important factors are hypertension, atrial fibrillation, history of recent myocardial infarction, diabetes, cigarette smoking, and alcohol abuse. Primary and secondary prevention of stroke by lifestyle changes, control of hypertension and diabetes, and therapeutic use of aspirin, warfarin, or angiotensin-converting enzyme inhibitors (ACEIs) will prevent further morbidity and mortality.

  • Cognitive decline in patients with Cushing's syndrome

  • HÉLÈNE FORGET, ANDRÉ LACROIX, MAURICE SOMMA, HENRI COHEN
  • Journal:
    Journal of the International Neuropsychological Society / Volume 6 / Issue 1 / January 2000
    Published online by Cambridge University Press:
    01 January 2000, pp. 20-29

  • Chronic exposure to elevated glucocorticoid levels in Cushing's syndrome (CS), is associated with deficits in cognitive function and in emotion. The hippocampus plays a crucial role in the behavioral manifestations of the syndrome as it is richest in glucocorticoid receptors and is thus particularly vulnerable to glucocorticoid excess. The wide distribution of glucocorticoid receptors throughout the cerebral cortex, however, suggests that several cognitive functions can also be affected by the dysregulation of glucocorticoids. In this study, we investigated how an excess of glucocorticoid hormones affects cognitive processes. Nineteen patients with chronic hypercortisolemia due to CS were compared to healthy controls matched for age, sex, education, and occupation in tests of processing of visual and spatial information, memory, reasoning and concept formation, language and verbal functions, and attention. Multivariate and univariate analyses revealed overall differences in tests of treatment of visual and spatial information, reasoning and concept formation as well as in verbal and language performance, with poorer performance from CS patients. Differences were also observed in nonverbal aspects of memory and in attention tasks. The results suggest that chronic exposure to elevated levels of cortisol is associated with deficits in several areas of cognition, particularly those involving processing of selective attention and visual components. This study also shows that hormones play an important role in the modulation of cognitive function and that their influence on cerebral structure and function merits closer scrutiny. (JINS, 2000, 6, 20–29.)

  • 6 - The hypothalamic-pituitary-adrenocortical system

  • Edited by Regina C. Casper, Stanford University, California
  • Book:
    Women's Health
    Published online:
    08 February 2010
    Print publication:
    13 December 1997, pp 109-121

  • Summary

    The hypothalamic-pituitary-adrenal (HPA) axis has undoubtedly received more psychobiologic scrutiny than any other endocrine axis. Historically, one rationale for the intensive study of adrenocortical function in patients with primary psychiatric disorders was the observation that patients with primary endocrine disorders such as Addison's disease or Cushing's syndrome exhibited a higher than expected psychiatric morbidity. The most intensive scrutiny of the HPA axis has been conducted in patients with major depression. Cushing's syndrome, due to prolonged exposure to excessive Cortisol or other related glucocorticoids, is accompanied by psychiatric symptoms of anxiety and/or depression that generally remit with diminution of abnormal glucocorticoid concentrations. Despite the higher incidence of depression in women than men and the purportedly increased occurrence of depression during and after menopause, the hypothalamic-pituitary-gonadal (HPG) axis has received relatively little scrutiny in patients with mood disorders.