scholarly journals Iatrogenic Hypercortisolism Complicating Triamcinolone Acetonide Injections in Patients with HIV on Ritonavir-Boosted Protease Inhibitors

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 489-493
Author(s):  
David Fessler
Keyword(s):  
Triamcinolone Acetonide ◽  
Inhaled Corticosteroids ◽  
Cushing Syndrome ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Epidural Injection ◽  
Serum Levels ◽  
High Serum ◽  
Systemic Absorption ◽  
Increased Risk

Epidural corticosteroid injection is a commonly used approach for managing back pain of several etiologies. The risk of clinical complications from systemic absorption is felt to be rare. Ritonavir is a protease inhibitor whose potent cytochrome P450 3A4 inhibition is exploited for pharmacologic boosting in human immunodeficiency virus (HIV) infection. It has been associated with systemic hypercortisolism when used in combination with nasal and inhaled corticosteroids. This is a case series describing 2 patients with HIV on ritonavir-containing regimens who developed iatrogenic hypercortisolism following epidural injection of triamcinolone acetonide. The 2 patients developed cushingoid symptoms, with detectable serum triamcinolone acetonide levels weeks after their epidural injections. Their symptoms took several weeks to resolve, in one case necessitating a change to an HIV regimen that did not contain ritonavir. Iatrogenic hypercortisolism is a rarely reported, but potentially devastating complication of injectable corticosteroids. Individuals receiving ritonavir-based therapy appear to be at increased risk for this process due to pharmacologic boosting of the corticosteroid. The preponderance of reported cases of iatrogenic hypercortisolism following injectable corticosteroids has involved triamcinolone acetonide, which may be due to the relatively rapid absorption characteristics and high serum levels of this compound compared with other preparations. For individuals on ritonavir-containing HIV therapy, we recommend close coordination with the involved HIV clinicians prior to use of injectable corticosteroids, and avoidance of injections with triamcinolone acetonide whenever possible. Choosing an alternative corticosteroid preparation to triamcinolone acetonide may reduce the risk of systemic absorption, though more research is needed to confirm this hypothesis. Key words: Epidural steroid injection, ritonavir, hypercortisolism, Cushing syndrome, HIV, injectable corticosteroids, P450 3A4, drug interaction.

Overt Glucocorticoid Excess Due to Inhaled Corticosteroid Therapy

PEDIATRICS ◽  
1988 ◽  
Vol 81 (3) ◽  
pp. 452-455
Author(s):  
Gregory A. Hollman ◽  
David B. Allen
Keyword(s):  
Triamcinolone Acetonide ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Serum Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Systemic Absorption ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis

Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticorsteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.

scholarly journals CSF-1 and Ang-2 serum levels — prognostic and diagnostic partners in non-small cell lung cancer

ESMO Open ◽  
2018 ◽  
Vol 3 (5) ◽  
pp. e000349 ◽  
Author(s):  
Ana Luísa Coelho ◽  
Mónica Patrícia Gomes ◽  
Raquel Jorge Catarino ◽  
Christian Rolfo ◽  
Rui Manuel Medeiros ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cancer Survival ◽  
Serum Levels ◽  
High Serum ◽  
Small Cell ◽  
Immune Checkpoints ◽  
Small Cell Lung ◽  
Increased Risk

BackgroundLung cancer is the most incident and lethal form of cancer, with late diagnosis as a major determinant of its bad prognosis. Immunotherapies targeting immune checkpoints improve survival, but positive results encompass only 30%–40% of the patients, possibly due to alternative pathways to immunosuppression, including tumour-associated macrophages (TAM). Colony stimulating factor-1 (CSF-1) is implicated in TAM differentiation and recruitment to tumours and in tumour angiogenesis, through a special setting of Tie-2-expressing macrophages, which respond to angiopoietin-2 (Ang-2). We evaluated the role of serum levels of CSF-1 in non-small cell lung cancer (NSCLC) prognosis and whether these could serve as biomarkers for NSCLC detection, along with Ang-2.Participants and methodsWe prospectively studied an unselected cohort of 145 patients with NSCLC and a group of 30 control individuals. Serum levels of Ang-2 and CSF-1 were measured by ELISA prior to treatment.ResultsSerum levels of CSF-1 and Ang-2 are positively correlated (p<0.000001). Individuals with high serum levels of CSF-1 have a 17-fold risk for NSCLC presence and patients with combined High Ang-2/CSF-1 serum levels present a 5-fold increased risk of having NSCLC. High Ang-2/CSF-1 phenotype is also associated with worst prognosis in NSCLC.ConclusionsCombined expression of CSF-1 and Ang-2 seems to contribute to worst prognosis in NSCLC and it is worthy to understand the basis of this unexplored partnership. Moreover, we think CSF-1 could be included as a biomarker in NSCLC screening protocols that can improve the positive predictive value of the current screening modalities, increase overall cost effectiveness and potentially improve lung cancer survival.

Serum levels of macrophage inhibitory cytokine-1 (MIC1) and matrix metallopeptidase-7 (MMP7) as diagnostic and prognostic markers in gastric cancer (GC) patients (pts).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14595-e14595
Author(s):  
Manuel Valladares-Ayerbes ◽  
Nuria Tarrío ◽  
Moisés Blanco-Calvo ◽  
Mar Haz-Conde ◽  
Isabel Santamarina Cainzos ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Serum Levels ◽  
High Serum ◽  
Youden Index ◽  
Matrix Remodeling ◽  
Diagnostic Potential ◽  
Increased Risk

e14595 Background: MIC1 and MMP7 are secreted cytokines involved respectively in the modulation of immunological processes and in extracellular matrix remodeling. Their expression were found deregulated in different tumors, including GC. However, few data are available about their serum levels, their diagnostic potential, and their prognostic significance in GC pts. Here, we analyze the diagnostic performance of these markers and we present data linking them with short survival in GC pts. Methods: Serum samples were assayed in duplicate for MIC1 and MMP7 levels by ELISA. The diagnostic performance of markers was assessed by ROC curve analysis and the cut-offs were set using the Youden index approach. The cut-offs for prognostic purposes were determined using X-tile software. Differences in progression free (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and logrank test. Cox regression was used to determine the prognostic independence of biomarkers. Results: From November 2006 to July 2010, 52 GC pts and 28 healthy donors were consecutively recruited. The follow-up of pts was performed until their death or the end of study (September 2011). The AUCs for MIC1 and MMP7 were respectively 0.897 and 0.865 (p < 0.001). Using the optimal cut-off to diagnose GC pts, we obtained a 73.08% of sensitivity (Ss) and a 92.86% of specificity (Sp) for MIC1, and a 78.85% of Ss and an 85.71% of Sp for MMP7. In the survival analysis, high serum levels of MIC1 and MMP7 were significantly associated with shorter PFS (p < 0.001) and OS (p < 0.001 and p = 0.003, respectively). In univariate analysis, pts with high serum levels of MIC1 and MMP7 had an increased risk of progression (HR = 3.608, p<0.001 for MIC1; HR = 4.172, p<0.001 for MMP7) and death (HR = 3.843, p=0.001 for MIC1; HR = 2.602, p=0.006 for MMP7). However, MIC1 and MMP7 failed to reach prognostic independence in multivariate analysis. Conclusions: We obtained cut-off values of MIC1 and MMP7 in serum for diagnostic purposes in GC. In addition, we established a correlation between increased levels of MIC1 and MMP7 in serum and shorter PFS and OS in GC. These findings justify studies with a larger number of pts.

scholarly journals Intralesional fenestration and corticosteroid injection for symptomatic Ledderhose disease of the foot: two case reports

2020 ◽  
Author(s):  
George Flanagan ◽  
Nicola Burt ◽  
Ian Reilly
Keyword(s):  
Triamcinolone Acetonide ◽  
Treatment Option ◽  
Local Anaesthetic ◽  
Case Reports ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Post Treatment ◽  
Lesion Volume ◽  
Scientific Papers ◽  
Ledderhose Disease

Abstract The description of corticosteroid injection as a treatment option for Ledderhose disease has received little attention in the literature and often merely receives a passing comment in scientific papers. We present a short case series of two patients that underwent corticosteroid injection in combination with fenestration to treat painful Ledderhose disease nodules. Both patients had their lesions injected on two occasions. Significant reduction in pain and lesion volume was seen at 12 months post treatment. Our protocol combines fenestration with the use of triamcinolone acetonide (mixed with local anaesthetic) which we believe conveys further advantage over corticosteroid infiltration alone.

scholarly journals Effects of the first three doses of benralizumab on symptom control, lung function, blood eosinophils, oral corticosteroid intake, and nasal polyps in a patient with severe allergic asthma

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090696 ◽  
Author(s):  
Corrado Pelaia ◽  
Maria Teresa Busceti ◽  
Alessandro Vatrella ◽  
Marco Ciriolo ◽  
Eugenio Garofalo ◽  
...  
Keyword(s):  
Nasal Polyps ◽  
Oral Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Serum Levels ◽  
Forced Expiratory Volume ◽  
High Serum ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Blood Eosinophils

Severe allergic eosinophilic asthma can be characterized by inadequate control, despite the regular use of high dosages of inhaled corticosteroids/long-acting β2-adrenergic agonists combinations, and the very frequent utilization of oral corticosteroids. Therefore, under these circumstances, an add-on biological treatment with monoclonal antibodies directed against suitable molecular targets, involved in the pathobiology of type-2 airway inflammation, is very useful. Within such a context, our case report refers to a 46-year-old woman with severe allergic eosinophilic asthma and relapsing nasal polyps, not eligible to add-on biological therapy with omalizumab because of her very high serum levels of immunoglobulins E (IgE). She is currently under treatment with the humanized monoclonal antibody benralizumab (30 mg subcutaneous injection, administered every 4 weeks for the first three doses, and every 8 weeks thereafter), an eosinophil-depleting anti-interleukin-5-receptor biologic. Our patient experienced relevant clinical and functional improvements already after the first dose, and subsequently striking changes were recorded after the second and third doses, including remarkable increases in asthma control test scores and forced expiratory volume in 1 s values, associated with a complete depletion of blood eosinophils and the interruption of oral corticosteroid intake, as well as with the concomitant disappearance of nasal polyps after the second dose. In conclusion, this case study suggests that benralizumab can exert a very rapid and effective therapeutic action in patients with severe eosinophilic asthma and nasal polyposis.

High serum levels of ferritin at baseline are not associated with an increased risk of mortality in oldest old community-dwelling adults: The OCTABAIX study

2016 ◽  
Vol 16 (2) ◽  
pp. 284-286
Author(s):  
Francesc Formiga ◽  
Assumpta Ferrer ◽  
Gloria Padros ◽  
Carme Gimenez-Argente ◽  
Rosa López Pisa ◽  
...  
Keyword(s):  
Oldest Old ◽  
Serum Levels ◽  
High Serum ◽  
Community Dwelling ◽  
Risk Of Mortality ◽  
Increased Risk

scholarly journals Intralesional fenestration and corticosteroid injection for symptomatic Ledderhose disease of the foot: Two case reports

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110118
Author(s):  
George Flanagan ◽  
Nicola Burt ◽  
Ian N Reilly
Keyword(s):  
Triamcinolone Acetonide ◽  
Treatment Option ◽  
Local Anaesthetic ◽  
Case Reports ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Lesion Volume ◽  
Scientific Papers ◽  
Ledderhose Disease ◽  
Corticosteroid Injections

The description of corticosteroid injections as a treatment option for Ledderhose disease has received little attention in the literature and often only receives a passing comment in scientific papers. We present a short case series of two patients who underwent corticosteroid injection in combination with fenestration to treat painful Ledderhose disease nodules. Both patients had their lesions injected on two occasions. Significant reduction in pain and lesion volume was seen at 12 months post treatment. Our protocol combines fenestration with the use of triamcinolone acetonide (mixed with local anaesthetic) which we believe conveys further advantage over other steroid preparations or the corticosteroid infiltration alone.

scholarly journals Intralesional fenestration and corticosteroid injection for symptomatic Ledderhose disease of the foot: two case reports

2021 ◽  
Author(s):  
George Flanagan ◽  
Nicola Burt ◽  
Ian Reilly
Keyword(s):  
Triamcinolone Acetonide ◽  
Treatment Option ◽  
Local Anaesthetic ◽  
Case Reports ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Lesion Volume ◽  
Scientific Papers ◽  
Ledderhose Disease ◽  
Corticosteroid Injections

Abstract The description of corticosteroid injections as a treatment option for Ledderhose disease has received little attention in the literature and often only receives a passing comment in scientific papers. We present a short case series of two patients that underwent corticosteroid injection in combination with fenestration to treat painful Ledderhose disease nodules. Both patients had their lesions injected on two occasions. Significant reduction in pain and lesion volume was seen at 12 months post treatment. Our protocol combines fenestration with the use of triamcinolone acetonide (mixed with local anaesthetic) which we believe conveys further advantage over other steroid preparations or the corticosteroid infiltration alone.

scholarly journals Associations between serum levels of calcium, parathyroid hormone and future risk of venous thromboembolism: the Tromsø study

2017 ◽  
Vol 176 (5) ◽  
pp. 625-634 ◽  
Author(s):  
Gunhild Lerstad ◽  
Ellen E Brodin ◽  
Johan Svartberg ◽  
Rolf Jorde ◽  
Jan Brox ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Venous Thromboembolism ◽  
Cox Regression ◽  
Adult Population ◽  
Serum Levels ◽  
Population Based ◽  
High Serum ◽  
Increased Risk ◽  
General Adult Population ◽  
Future Risk

ObjectiveThe relationship between serum levels of calcium, parathyroid hormone (PTH) and risk of venous thromboembolism (VTE) has not been addressed in population-based cohorts. We investigated the associations between serum levels of calcium and PTH, with future risk of VTE in a general adult population.DesignPopulation-based cohort.MethodsA total of 27 712 subjects (25–87 years) who participated in Tromsø 4 (1994–1995) and Tromsø 5 (2001–2002) surveys were included in the study, and total calcium and PTH were measured in 27 685 and 8547 subjects respectively. Incident VTE was recorded through December 31, 2012. Cox-regression models with calcium and PTH as time-varying exposures were used to calculate hazard ratios (HR) of VTE by quartiles of calcium and PTH. Quartiles of calcium and PTH were also combined to assess the effect of discordants of both PTH and calcium (e.g. highest and lowest quartiles of both calcium and PTH) on VTE risk using the middle two quartiles as reference.ResultsThere were 712 VTEs during 15.0 years of median follow-up. Serum levels of calcium and PTH were not associated with risk of VTE. However, subjects with discordant high serum levels of both calcium and PTH (calcium ≥2.45 mmol/L and PTH ≥4.0 pmol/L) had increased risk of VTE compared to those in subjects with normal calcium and PTH (multivariable HR: 1.78, 95% CI: 1.12–2.84).ConclusionsSerum levels of calcium and PTH separately were not associated with future risk of VTE, but subjects with high levels of both calcium and PTH had increased risk of VTE compared to those in subjects with normal levels.

scholarly journals Budesonide nebulization in preterm neonates with evolving brochopulmonary dysplasia after 14 days of life: a case series

2021 ◽  
Vol 8 (9) ◽  
pp. 1594
Author(s):  
Subhodh Shetty S. ◽  
J. Ashok Raja ◽  
N. Muthukumaran
Keyword(s):  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Inhaled Corticosteroids ◽  
Pulmonary Inflammation ◽  
Case Series ◽  
Preterm Neonates ◽  
Safe Alternative ◽  
Systemic Corticosteroids ◽  
Increased Risk ◽  
Inhaled Budesonide

Bronchopulmonary dysplasia (BPD) with oxygen dependence at 36 weeks postmenstrual age (PMA), remains an important complication of premature newborns. BPD occurs due to pulmonary inflammation. Reducing pulmonary inflammation with postnatal systemic corticosteroids reduces the incidence of BPD but is associated with an increased risk of long and short-term side effects. Local administration of corticosteroids via inhalation might be an effective and safe alternative. Currently, there is no recommendation for use of inhaled corticosteroids in neonatal respiratory care. However, it is being used in neonatal intensive care units (NICU) across the world in ventilator and oxygen-dependent babies. We shared our experience with the use of inhaled budesonide on nine ventilator-dependent very low birth weight (VLBW) preterm neonates in the form of case series and review the literature. 

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