Rapidly developing Cushing syndrome in a 4-year-old patient during combined treatment with itraconazole and inhaled budesonide

Eur J Pediatr. 2003 Jul;162(7-8):488-489. doi: 10.1007/s00431-003-1233-8. Epub 2003 Apr 26.


A 4-year-old boy with cystic fibrosis developed hypertension, rapid weight gain and a moon face 2 weeks after starting a combined treatment of oral itraconazole and inhaled budesonide for a suspected allergic bronchopulmonary aspergillosis. Adrenal suppression was documented and found to persist 3 months after stopping this combined treatment.

Conclusion: To the best of our knowledge, this is the first time that an iatrogenic Cushing syndrome in a young child with cystic fibrosis after such combined treatment is reported. The inhibition of cytochrome P4503A by intraconazole and a higher glucocorticoid tissue sensitivity is suggested as the underlying mechanism.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents / adverse effects*
  • Antifungal Agents / therapeutic use*
  • Aspergillosis, Allergic Bronchopulmonary / drug therapy
  • Aspergillosis, Allergic Bronchopulmonary / epidemiology
  • Budesonide / adverse effects*
  • Child, Preschool
  • Comorbidity
  • Cushing Syndrome / chemically induced*
  • Cystic Fibrosis / epidemiology
  • Drug Therapy, Combination
  • Humans
  • Itraconazole / adverse effects*
  • Male
  • Time Factors


  • Anti-Inflammatory Agents
  • Antifungal Agents
  • Itraconazole
  • Budesonide