A 41-year-old male patient with a history of HIV, smoking COPD and severe pneumonia caused by P. jirovecii.
Since 2012, treated with: lamivudine (150 mg/day), tenofovir (300 mg/day), atazanavir (300 mg/day) and ritonavir (100 mg/day).
During the last 7 months, fluticasone/salmeterol (1,000 ug/100 ug/day) was added to the treatment, respecting doses.
She was admitted to the emergency department with bilateral, sharp, non-irradiated low back pain for 5 months and VAS 8/10.
Associated with asthenia, progressive weight gain.
She was hospitalized for study.
He was admitted with arterial hypertension (150/96 mmHg) and africa.
Physical examination revealed a BMI of 38 kg/m2 kg/m2 for 10 months), abdominal perimeter (210 cm) and quadroid phenotype.
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It was studied with laboratory tests, highlighting changes in: 24-h urinary free cortisol (CLU), Liddle test (local readings) and ACTH.
With these results, a contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed normal adrenal glands in shape and size.
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In radiographs of the lumbar spine crush fractures were investigated at the level of T12 to L3; confirmed by CT of the lumbar spine and bone densitometry reported T score: -4.75 SD in femoral neck.
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From the findings in the endocrinological laboratory and imaging, it was concluded that the clinical picture was secondary to SCI by exogenous corticoids (CE); being fluticasone/ritonavir, the most probable association.
For these reasons, both drugs were suspended, and for one month, oral cortisol (30 mg/day), indametal decay/severe: ug/day) replaced fluticasone/800 mg trimethoprim/salmeterol.
Calcium/calciferol (375 mg/150 IU/day) was administered concomitantly with calcium/calciferol (150 mg/month) for lumbar osteoporosis.
The patient was discharged after achieving analgesia with subcutaneous buprenorphine 35 ug and amitriptyline 25 mg/day.
The hypothalamic-pituitary-adrenal (HHA) axis was reviewed at 3 months after fluticasone/ritonavir discontinuation and at 2 months without cortisol. Baseline cortisol was 16 ng/ml.
The patient was asymptomatic, normotensive, with a BMI of 35 kg/m2 and with regression of the quadroid phenotype at 8 months of follow-up.
