Hypothalamic-pituitary-adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients.

Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic-pituitary-adrenal suppression by local corticosteroids in HIV-infected patients. Method Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic-pituitary-adrenal axis was defined as a morning plasma cortisol below 80 nmol/L or a cortisol below 550 nmol/L during a 250 mcg adrenocorticotropic hormone-stimulation test. Results Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamic-pituitary-adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. Conclusion Hypothalamic-pituitary-adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4.ClinicalTrials.gov Identifier NCT02501486.

Vesiculopustular dermatosis: an uncommon side-effect of liraglutide?

Liraglutide is a GLP-1 receptor agonist, a novel medication for type 2 diabetes. We describe a case of pustules in a patient recently started on liraglutide. Common side effects of liraglutide are gastrointestinal disorders. Skin and tissue reactions are less well-known side effects. Liraglutide could be the cause of skin eruptions in this patient, possibly by immunogenicity.

Risks of colon and rectal adenomas are differentially associated with anthropometry throughout life: the French E3N prospective cohort.

BACKGROUND: Associations between adult anthropometry and risk of colorectal neoplasms are well established. However, whereas body mass in infancy and childhood has been associated with risk of some cancers, little is known about potential associations with colorectal neoplasms. The authors investigated associations between colorectal adenoma risk and lifetime anthropometry, in an attempt to better understand the relationships between anthropometric features and colorectal carcinogenesis. METHODS: Among the 17 391 women of the French E3N cohort who underwent a colonoscopy during follow-up (1993-2002), 1408 developed a first colorectal adenoma. Associations were estimated with Cox multivariate proportional hazard regression models. RESULTS: Left colon adenoma risk was associated with high birth weight [hazard ratio (HR) high vs median = 1.21; 95% confidence interval (95% CI): 1.00-1.47, P(trend) = 0.03] and large adult body shape (HR = 1.28; 95% CI: 1.04-1.56, P(trend) = 0.02). A large versus small body shape at age 8 years and at menarche were associated with a decreased rectal adenoma risk [HR = 0.68; 95% CI: 0.49-0.95, P(trend) = 0.01 and 0.73 (0.53-1.01), P(trend) = 0.05, respectively]. Except for a positive association with large vs median birth weight, no anthropometric characteristic was associated with right colon adenoma risk. Associations did not differ between advanced and non-advanced adenomas. CONCLUSIONS: These findings suggest that early life events may influence early stages of colorectal carcinogenesis and add to the evidence of differential pathways of carcinogenesis in the right colon, left colon and rectum.