Fluconazole as a safe and effective alternative to ketoconazole in controlling hypercortisolism of recurrent Cushing’s disease: a case report

Chai, Shu Teng and Haydar Ali Tajuddin, Amalina and Abdul Wahab, Norasyikin and Mustafa, Norlaila and Sukor, Norlela and Kamaruddin, Nor Azmi (2018) Fluconazole as a safe and effective alternative to ketoconazole in controlling hypercortisolism of recurrent Cushing’s disease: a case report. international Journal of Endocrinology and Metabolism, 16 (3). pp. 1-5. ISSN 1726-913X E-ISSN 1726-9148

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Abstract

Introduction: Ketoconazole has long been the first-line medical therapy for controlling hypercortisolism secondary to either pituitary or adrenal pathology. However, it is largely unavailable in most countries. As a result, we have turned to fluconazole as a viable alternative in view of its favourable safety profile. Case Presentation: A 50-year-old lady developed recurrent Cushing’s disease after being in remission following transsphenoidal surgery (TSS) for a left pituitary microadenoma 16 years ago. The repeat MRI showed a right pituitary microadenoma (1.7 mm � 1.3 mm) for which she underwent a second TSS. However, she continued to have persistent hypercortisolism despite repeated MRIs showing absence of tumour recurrence. She refused bilateral adrenalectomy and external radiotherapy. Ketoconazole was commenced at 200 mg twice daily for disease control but this was hindered by intolerable side effects including pruritus and skin exfoliation. In the meantime, she suffered a right hypertensive basal ganglia hemorrhage. Treatment was subsequently switched to cabergoline and the dose titrated to 0.5 mg daily. Fluconazole 400 mg daily was later added to control the persistent disease. Her clinical and biochemical parameters improved markedly three months after the addition of fluconazole. No adverse event was reported. Her disease has remained stable for the last 15 months up until the time of the recent clinic review. Conclusions: This case demonstrates the long-term efficacy of fluconazole in tandem with cabergoline for the control of recurrent Cushing’s disease.

Item Type:	Article (Case Report)
Additional Information:	Authors’ Contribution: Shu Teng Chai wrote the article body of the manuscript. Amalina Haydar Ali Tajuddin wrote the abstract. Norasyikin A.Wahab, Norlaila Mustafa, Norlela Sukor and Nor Azmi Kamaruddin provided consultation for the patient. Nor Azmi Kamaruddin edited the final draft of the manuscript. Financial Disclosure: There are no financial interests in relation to the materials in the manuscript to disclose.
Uncontrolled Keywords:	Cabergoline, Ketoconazole, Fluconazole, Pituitary ACTH Hypersecretion, Pruritus, Magnetic Resonance Imaging
Subjects:	R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Internal Medicine Kulliyyah of Medicine
Depositing User:	Dr Amalina Haydar Ali Tajuddin
Date Deposited:	23 Nov 2020 08:36
Last Modified:	23 Nov 2020 08:36
URI:	http://irep.iium.edu.my/id/eprint/84960

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