RESUMO
Long-acting steroids (LAS) are widely used to treat various inflammatory diseases and allergies. They have many adverse effects including the inhibition of the hypothalamopituitary axis that can last several months. LAS are also strong immunosuppressors and can result in severe opportunistic infections and immunodeficiency-related malignancies. However, the time needed for immune recovery after withdrawal of LAS is unknown. Here we report a case of Kaposi's sarcoma (KS) and severe immunosuppression after a chronic triamcinolone acetonide (TA) treatment. Six months after withdrawal, traces of TA were still detected in the serum by HPLC mass spectrometry. At 8 months, the drug became undetectable, and clinical and biological signs of immune recovery - beginning of KS regression, normalization of IgG levels and CD4 T lymphocyte counts - became noticeable. We then provide a review of the literature on the time until remission of KS after immunosuppression reduction. We also reviewed the cases of KS induced by TA, and the metabolic side effects of TA when compared to standard glucocorticoids.
Assuntos
Anti-Inflamatórios/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Infecções Oportunistas/imunologia , Sarcoma de Kaposi/imunologia , Triancinolona Acetonida/efeitos adversos , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/sangue , Bleomicina/uso terapêutico , Glicemia/efeitos dos fármacos , Contagem de Linfócito CD4 , Humanos , Imunoglobulina G/sangue , Insulina/uso terapêutico , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/patologia , Paclitaxel/uso terapêutico , Sarcoma de Kaposi/patologia , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/imunologia , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/sangueAssuntos
Insuficiência de Crescimento/induzido quimicamente , Hemangioma Capilar/tratamento farmacológico , Triancinolona Acetonida/efeitos adversos , Testes de Função do Córtex Suprarrenal , Feminino , Humanos , Recém-Nascido , Injeções Intralesionais , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/sangueRESUMO
As measured by depression of plasma cortisol following intranasal injection of 40 mg triamcinolone acetonide, slight systemic absorption was evident after three days in approximately 60% of patients studied. However, cortisol values were not lowered below normal limits at any time. No adrenal suppression was apparent after repeated injections. Comparison is made with the effect on plasma cortisol of triamcinolone administered by intramuscular or intra-articular injection.
Assuntos
Triancinolona Acetonida/farmacologia , Conchas Nasais/efeitos dos fármacos , Absorção , Adolescente , Adulto , Idoso , Feminino , Humanos , Hidrocortisona/sangue , Injeções , Injeções Intra-Articulares , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Triancinolona Acetonida/sangueAssuntos
Leucemia Linfoide/sangue , Linfócitos/metabolismo , Neoplasias Hormônio-Dependentes/sangue , Receptores de Glucocorticoides , Receptores de Esteroides , Idoso , Núcleo Celular/metabolismo , Citosol/metabolismo , Dexametasona/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peso Molecular , Receptores de Glucocorticoides/isolamento & purificação , Receptores de Esteroides/isolamento & purificação , Triancinolona Acetonida/sangueRESUMO
Pharmacologic doses of triamcinolone hexacetonide were injected intramuscularly or intraarticularly in immature Papio papio baboons. The mandibular condyle served as a model for histologic examinations concerning the effect of glucocorticoid hormone on cartilage and bone. Biochemical examinations of blood and urine indicated the development of distinct hypophosphatemia, hypercalcemia followed by hyperphosphaturia, and hypocalciuria. Serum alkaline phosphatase activity rose during the initial phases of the experiment but decreased considerably after the sixth injection of the hormone. Hyperglycemia and an increase in serum amylase were noticed along with signs of moderate metabolic acidosis. Histologic examinations disclosed signs of severe destruction of cartilage and bone. By the sixth intraarticular injection, definite fibrillation was noted in the articular cartilage, followed by complete disappearance of cartilage. The subchondral bone appeared to be adversely affected by the hormone as it lost its typical lamellar organization and attained the characteristics of woven bone. The condyle showed clear signs of fibro-osseous transformation, with fibrosis as the dominant structural feature. The preceding biochemical and morphologic findings are indicative of parathyroid hyperactivity.