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Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis

Adult CF Unit Papworth Hospital, Papworth NHS Trust, Papworth Everard, Cambridge CB3 8RE, UK

Correspondence to:
Correspondence to:
Dr J S Parmar, Adult CF Unit, Papworth NHS Trust, Papworth Everard, Cambridge CB3 8RE, UK;
jsp35{at}hermes.cam.ac.uk

ABSTRACT
The case history is presented of a patient with cystic fibrosis in whom the treatment of allergic bronchopulmonary aspergillosis with itraconazole produced an initial response but was complicated by profound adrenal shutdown and impairment of inhaled steroid clearance resulting in paradoxical Cushing’s syndrome. The authors conclude that, while it is laudable to attempt to reduce the steroid burden in any patient, it is imperative that due vigilance is exercised when using a combination of agents which interact. If such a combination therapy is embarked upon, regular assessment of the pituitary adrenal axis is advisable.

Keywords: cystic fibrosis; allergic bronchopulmonary aspergillosis; adrenal suppression; itraconazole

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