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ISSN : 1225-0082(Print)
ISSN : 2288-1905(Online)
The Medical Journal of Chosun University Vol.38 No.1 pp.42-45

Betamethasone Diproprinate/Clotrimazole 도포 후 급격히 발생한
의인성 쿠싱증후군 1예

소중해, 김석원, 최영민, 배학연, 김상용, 김진화*
조선대학교 의학전문대학원 내과학교실

A Case of Rapidly Developing Iatrogenic Cushing’s Syndrome after Short-term Application of Topical Agent of Betamethasone Diproprinate/Clotrimazole Combination Ointment

Jin Hwa Kim*, Jung Hae So, Seok Won Kim, Young Min Choi, Hak Yeon Bae, Sang Yong Kim
Department of Internal Medicine, College of Medicine, Chosun University
(Received February 20, 2013; Accepted March 15, 2013)


Demacort® is mixture of betamethasone (high-potency corticosteroid) and clotrimazole (antifungal agent), an inhibitor ofCYP3A4, which can inhibit the metabolism of betamethasone. Interaction of these drugs may result in decreased clearanceof betamethasone and increased risk for adverse events such as iatrogenic Cushing’s syndrome. A 26-year-old female wasadmitted to the hospital due to rapid weight gain after application of Demacort®. During a period of one month, she showedweight gain of 30 kg and developed several Cushingoid appearances. The result of an overnight dexamethasone suppressiontest was negative, thus, endogenous Cushing’s syndrome was ruled out. A negative cortisol response was observed for therapid ACTH stimulation test; therefore, we made a diagnosis of iatrogenic Cushing’s syndrome combined with additionalsecondary adrenal insufficiency.


1.Rachel L. Hopkins, Matthew C. Exogenous Cushing's syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin N Am 2005; 34: 371-384.
2.Sim D, Griffiths A, Armstrong D, Clarke C, Rodda C, Freezer N. Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma. Eur Respir J 2003; 21: 633-6.
3.Wilson AM, Blumsohn A, Jung RT, Lipworth BJ. Asthma and Cushing's syndrome. Chest 2000; 117: 593-4.
4.Lipworth BJWA. Dose response to inhaled corticosteroids: benefits and risks. Semin Respir Crit Care Med 1998; 19: 625-46.
5.Yombi JC, Maiter D, Belkhir L, Nzeusseu A, Vandercam B. Iatrogenic Cushing's syndrome and secondary adrenal insufficiency after a single intra-articular administration of triamcinolone acetonide in HIV-infected patients treated with ritonavir Clin Rheumatol. Suppl 2008; 2 : S79-S82.
6.Bolland MJ, Bagg W, Thomas MG, Lucas JA, Ticehurst R, Black PN. Cushing's syndrome due to interaction between inhaled corticosteroid and itraconazole. Ann Pharmacother. 2004; 38: 46-49.
7.Stefan RB. Predisposing factors for adrenal insufficiency. N EnglJ Med 2009; 360: 2328-2339.
8.Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006; 54: 1-15.
9.Varis T, Kivisto KT, Backman JT, Neuvonen PJ. The cytochrome P450 3A4 inhibitor itraconazole markedly increases the plasma concentrations of dexamethasone and enhances its adrenal-suppressant effect. Clin Pharmacol Ther 2000; 68: 487-94.
10.Zhang W, Ramamoorthy Y, Kilincarslan T, Nolte H, Tyndale RF, Sellers EM. Inhibition of cytochrome P450 by antifungal imidazole derivatives. Drug Metabolism and Disposition 2002; 30:L314-318.
11.Newfield RS, Kalaitzoglou G, Licholai T, Chilton D, Ashraf J, Thompson EB. New MI: Normocortisoleic Cushing's syndrome initially presenting with increased glucocorticoid receptor numbers. J Clin Endocrinol Metab 2000; 85: 14-21.
12.Russcher H, Smit P, van Rossum EF, van den Akker EL, Brinkmann AO, de Heide LJ, de Jong FH, Koper JW, Lambert SW. Strategies for the characterization of disorders in cortisol sensitivity. J Clin Endocrinol Metab 2006; 91: 694-701.