Secondary adrenal insufficiency due to the co-administration of ritonavir and inhaled fluticasone propionate - case report

Ritonavir is a powerful inhibitor of the cytochrome P450 3A4 [CYP3A4] isoenzyme. It is used as a pharmaceutical enhancer in the management of HIV-positive patients. However, when co-administered with other drugs that are metabolised via the CYP3A4 pathway, ritonavir can potentially cause serious drug-drug interactions. Inhaled fluticasone propionate, which is used to treat asthma and chronic obstructive airway disease, is particularly prone to such interactions due to its physiological attributes. We report a HIV-positive 48-year-old male patient who presented to Al Nahdha Hospital, Muscat, Oman, in 2012 with weight loss, generalised weakness and fatigue and diagnosed with secondary adrenal insufficiency as a result of concomitant ritonavir and inhaled fluticasone

Clinical and epidemiological characteristics of pituitary tumors using a web-based pituitary tumor registry in Oman

From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance [MRI] and the different treatment modalities. All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 1998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry. A total of 160 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 +/- 12 years [age range 8-73 years]. The majority of registrations were female [n=114; 71%]. There were 81 patients with non-functioning adenomas [50.6%], 59 with prolactinoma [36.9%] eight with acromegaly [5%], seven with craniopharyngioma [4.4%], four with Cushing's disease [2.5%] and one with sarcoidosis [0.6%]. Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours [non-functioning adenomas, prolactinomas, and acromegaly]. The most prevalent symptoms are amenorrhea-galactorrhea [n=55; 37%], headache [n=31; 21%] and fatigue [n=23; 16%]. The most common treatment modality was medical [n=58; 39%], followed by observation [n=56; 38%], surgery [n=31; 21%] and surgery plus medical [n=3; 2%]. None of the patients in this registry are recorded to have died. To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman