Persistent Adrenal Insufficiency Secondary to Low-Dose Ketoconazole Therapy

Best, Tim; Jenkins, John K.; Murphy, Fred Y.; Nicks, Sally A.; Bussell, K L; Vesely, David L.

doi:10.1016/s0022-5347(17)43638-x

Cited by 9 publications

(10 citation statements)

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“…Within days of discontinuation ofketoconazole, symptoms and laboratory abnormalities resolved completely. A second patient with pulmonary blastomycosis receiving ketoconazole 400mg daily developed chronic symptomatic adrenal insufficiency that persisted over 2 years of follow-up and required glucocorticoid replacement (Best et al 1987).…”

Section: Hormonal Effectsmentioning

confidence: 99%

Adverse Drug Reactions to Systemic Antifungals Prevention and Management

1992

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Systemic administration of antifungal agents for invasive mycoses has dramatically increased over the past 10 years in many fields of medicine. The increase has been due both to an increasing immune compromised population and to potent antibacterial agents which allow these fungi to invade tissue. It is apparent that our understanding of the use of both the old and new antifungal agents has significantly increased in the last few years. In this review, we attempt to document our extensive knowledge of the adverse effects of the polyenes, flucytosine, griseofulvin and azoles when given systemically for treatment. Interwoven in this documentation of the adverse reactions to these agents is the attempt to help clinicians potentially avoid some of these adverse effects and if they do occur, to be able to identify and successfully manage them.

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Section: Hormonal Effectsmentioning

confidence: 99%

Adverse Drug Reactions to Systemic Antifungals Prevention and Management

1992

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“…One recent report documented a chronic adrenal insufficiency in a patient undergoing low-dose (400 mg/day) ketoconazole treatment for-blastomycosis (27). The syntheses of testosterone (250) and cholesterol (165) are directly affected by ketoconazole.…”

Section: Ketoconazolementioning

confidence: 99%

Overview of medically important antifungal azole derivatives

1988

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Fungal infections are a major burden to the health and welfare of modern humans. They range from simply cosmetic, non-life-threatening skin infections to severe, systemic infections that may lead to significant debilitation or death. The selection of chemotherapeutic agents useful for the treatment of fungal infections is small. In this overview, a major chemical group with antifungal activity, the azole derivatives, is examined. Included are historical and state of the art information on the in vitro activity, experimental in vivo activity, mode of action, pharmacokinetics, clinical studies, and uses and adverse reactions of imidazoles currently marketed (clotrimazole, miconazole, econazole, ketoconazole, bifonazole, butoconazole, croconazole, fenticonazole, isoconazole, oxiconazole, sulconazole, and tioconazole) and under development (aliconazole and omoconazole), as well as triazoles currently marketed (terconazole) and under development (fluconazole, itraconazole, vibunazole, alteconazole, and ICI 195,739).

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“…In all cases, hepatitis is reversible when the treatment is stopped and the very few cases ofdeath attributable to KC occurred in patients in whom the drug has been continued after the onset of the symptoms of hepatitis. Adrenal insufficiency is also a rare event in the setting of KC therapy (Best et al, 1987;Khosla et al, 1989;Pillans et al, 1985;Tucker er al., 1985;White & Kendall-Taylor, 1985). In one of our patients who experienced KC-induced hypoadrenalism, the reduction of the KC daily dose together with the administration of replacement steroids allowed an adequate control of the disease.…”

Section: Discussionmentioning

confidence: 99%

Use of ketoconazole in the treatment of Cushing's disease and ectopic ACTH syndrome

Tabarin

Navarranne

Guérin

et al. 1991

Clinical Endocrinology

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Ketoconazole, an imidazole derivative which inhibits adrenal steroidogenesis, has been used with success for the metabolic control of Cushing's disease. Few data are available about the use of ketoconazole in the management of the ectopic ACTH syndrome. We have used ketoconazole in eight patients: four patients with Cushing's disease, two patients with overt and two with occult ectopic ACTH syndrome. Among patients with Cushing's disease, reversible hypoadrenalism occurred once. All had full clinical and biochemical regression of the disease for more than 6 months with 400-1200 mg ketoconazole per day. Patients with ectopic ACTH syndrome received 1200 mg ketoconazole per day for at least 2 months. Partial biochemical regression was observed in two and a secondary escape to adrenal blockade in two others. These findings further indicate that ketoconazole is a valuable tool for the metabolic control of Cushing's disease. On the contrary, in ectopic ACTH syndrome, this aim can be impossible to reach with ketoconazole although the reasons for its ineffectiveness remain to be determined.

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Persistent Adrenal Insufficiency Secondary to Low-Dose Ketoconazole Therapy

Cited by 9 publications

References 0 publications

Adverse Drug Reactions to Systemic Antifungals Prevention and Management

Adverse Drug Reactions to Systemic Antifungals Prevention and Management

Overview of medically important antifungal azole derivatives

Use of ketoconazole in the treatment of Cushing's disease and ectopic ACTH syndrome

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