Ketoconazole treatment in Cushing's syndrome: experience in 34 patients

Sonino, Nicoletta; Boscaro, Marco; Paoletta, Agostino; Mantero, Franco; Ziliotto, D

doi:10.1111/j.1365-2265.1991.tb03547.x

Cited by 195 publications

(149 citation statements)

References 18 publications

Supporting

Mentioning

134

Contrasting

Unclassified

Order By: Relevance

“…Liver enzyme dysfunction may occur in up to 10% of the cases. Recommended starting dose is 200 mg twice a day, increasing to 1,200 mg/day, divided in four doses (15,16).…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebri during Cushing's disease treatment with ketoconazole

Costenaro

Rodrigues

Ferreira

et al. 2011

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

SUMMARYBenign intracranial hypertension (Pseudotumor cerebri) has been described as related to the reduction in steroid levels in Cushing's disease (CD), especially after surgical remission. Ketoconazole is a common and effective adjuvant therapy for hypercortisolism, but the major concern is liver enzyme dysfunction. We describe here the case of a 12-year old girl with CD who developed benign intracranial hypertension during treatment with ketoconazole. She presented headache, vomiting, a black spot on her right temporal visual field, and signs of elevated intracranial pressure. Pituitary image was normal on magnetic resonance image (MRI), and all symptoms improved after treatment with acetazolamide. We call attention to the diagnosis of this disorder in CD patients, especially children on ketoconazole treatment, because it could be confounded with adrenal insufficiency and lead to definitive severe visual impairment. Arq Bras Endocrinol Metab. 2011;55(4):284-7 SUMÁRIOHipertensão intracraniana benigna (Pseudotumor cerebral) tem sido descrita relacionada à redução dos níveis de esteroides séricos na doença de Cushing (DC), especialmente após a remissão cirúrgica. O cetoconazol é uma opção efetiva e de uso rotineiro como adjuvante na terapêutica do hipercortisolismo, tendo como paraefeito mais temido a toxicidade hepática. Relatamos o caso de uma menina com 12 anos de idade portadora de DC que desenvolveu hipertensão intracraniana benigna durante tratamento com cetoconazol. Apresentou-se com cefaleia, vômitos, comprometimento do campo visual temporal direito e sinais de hipertensão intracraniana. A ressonância magnética (RM) de hipófise era normal e todos os sinais e sintomas resolveram-se com uso de acetazolamida. Chamamos a atenção para esse diagnóstico nos pacientes com DC, especialmente crianças, em tratamento com cetoconazol, porque ele pode ser confundido com insuficiência adrenal e causar comprometimento visual severo e definitivo. Arq Bras Endocrinol Metab. 2011;55(4):284-7

show abstract

“…Liver enzyme dysfunction may occur in up to 10% of the cases. Recommended starting dose is 200 mg twice a day, increasing to 1,200 mg/day, divided in four doses (15,16).…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebri during Cushing's disease treatment with ketoconazole

Costenaro

Rodrigues

Ferreira

et al. 2011

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

show abstract

“…between 400 and 1600 mg/day (Castinetti et al 2008). Its main mechanism of action is inhibition of the steroidogenic enzymes 17-hydroxylase and 17,20-lyase and it is one of the most frequently used cortisol-lowering drugs (Engelhardt et al 1985, Loli et al 1986, Lamberts et al 1987, McCance et al 1987, Sonino 1987, Farwell et al 1988, Sonino et al 1991, Castinetti et al 2008. Ketoconazole is hepatotoxic, can cause gynecomastia, and has serious, mainly gastrointestinal, side effects, which together can limit its long-term use (McCance et al 1987, Sonino et al 1991, Como & Dismukes 1994, Nieman 2002, Castinetti et al 2008.…”

Section: Inhibitors Of Adrenocortical Steroidogenesismentioning

confidence: 99%

New developments in the medical treatment of Cushing's syndrome

Pas¹,

Herder²,

Hofland³

et al. 2012

Endocrine-Related Cancer

View full text Add to dashboard Cite

Cushing's syndrome (CS) is a severe endocrine disorder characterized by chronic cortisol excess due to an ACTH-secreting pituitary adenoma, ectopic ACTH production, or a cortisol-producing adrenal neoplasia. Regardless of the underlying cause, untreated CS is associated with considerable morbidity and mortality. Surgery is the primary therapy for all causes of CS, but surgical failure and ineligibility of the patient to undergo surgery necessitate alternative treatment modalities. The role of medical therapy in CS has been limited because of lack of efficacy or intolerability. In recent years, however, new targets for medical therapy have been identified, both at the level of the pituitary gland (e.g. somatostatin, dopamine, and epidermal growth factor receptors) and the adrenal gland (ectopically expressed receptors in ACTH-independent macronodular adrenal hyperplasia). In this review, results of preclinical and clinical studies with drugs that exert their action through these molecular targets, as well as already established medical treatment options, will be discussed.

show abstract

“…It is the most frequently used agent in the treatment of Cushing's syndrome with the starting dose being 200 mg twice daily increasing as necessary to 1200 mg/day in four divided doses (12,13). In contrast to metyrapone it can take several weeks to see the full benefit of a dose adjustment and there is less risk of over-treatment and hypoadrenalism.…”

Section: Ketoconazolementioning

confidence: 99%

Pharmacological management of Cushing's syndrome: an update

Dang

Trainer

2007

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

The treatment of choice for Cushing's syndrome remains surgical. The role for medical therapy is twofold. Firstly it is used to control hypercortisolaemia prior to surgery to optimize patient's preoperative state and secondly, it is used where surgery has failed and radiotherapy has not taken effect. The main drugs used inhibit steroidogenesis and include metyrapone, ketoconazole, and mitotane. RESUMOManejo Farmacológico da Síndrome de Cushing: Uma Atualização. O tratamento de escolha para a síndrome de Cushing ainda é a cirurgia. O papel da terapia medicamentosa é duplo: ele é usado para controlar o hipercortisolismo antes da cirurgia e otimizar o estado pré-operatório do paciente e, adicionalmente, quando ocorre falha cirúrgica e a radioterapia ainda não se mostrou efetiva. Os principais medicamentos são empregados para inibir a esteroidogênese e incluem: metirapona, cetoconazol e mitotano. Medicamentos visando o eixo hipotálamo-hipofisário têm sido investigados, mas seu papel na prática clínica permanece limitado, embora o agonista PPAR-γ e análogo de somatostatina, som-230 (pasireotídeo), requeira estudos adicionais. A única droga que age perifericamente no receptor glicocorticóide é a mifepristona (RU486). O manejo da síndrome de Cushing deve envolver uma combinação terapêutica atuando em diferentes vias da hipercortisolemia, mas o monitoramento dessa terapia ainda permanece um desafio. (Arq Bras Endocrinol Metab

show abstract

Ketoconazole treatment in Cushing's syndrome: experience in 34 patients

Abstract: These data confirm that ketoconazole is valuable in the management of hypercortisolism, provided that patients are closely watched to exclude those who may develop liver toxicity and to prevent the occurrence of adrenal insufficiency.

Cited by 195 publications

References 18 publications

Pseudotumor cerebri during Cushing's disease treatment with ketoconazole

Pseudotumor cerebri during Cushing's disease treatment with ketoconazole

New developments in the medical treatment of Cushing's syndrome

Pharmacological management of Cushing's syndrome: an update

Contact Info

Product

Resources

About