Ketoconazole and Cushing’s syndrome

July 11, 2008

Ketoconazole belongs to a class of drugs called imidazole derivatives, normally used to treat fungal infections. It also inhibits key steps in the syntheses of mineralocorticoids and glucocorticoids, the first step in cortisol synthesis, according to a report from Harvard Medical School. As an adrenal steroid inhibitor, it is recommended in the treatment of Cushing syndrome.

Endocrinology Journal reported from Chang Gung University in Taiwan on three patients who had residual or recurring Cushing’s disease after surgical treatment. Ketoconazole was administered orally and adjusted according to individual response based on lab testing. Based on follow-up periods up to 83 months, the researchers concluded that ketoconazole was a valuable therapy when surgery is contraindicated or unsuccessful.

A report from the University of Montreal in Canada on Cushing’s syndrome noted that ketoconazole is one of various drugs that inhibits steroid synthesis and can be effective for rapidly controlling hypercortisolism either in preparation for surgery, after unsuccessful removal of the causative tumor, or while awaiting the full effect of radiotherapy or more definitive therapy.

Clinical and Experimental Pharmacology and Physiology reported on eight patients with Cushing’s disease who were given ketoconazole for two weeks. Large reductions in urine excretion of free cortisol and cortisol metabolites were seen, and the researchers concluded it was clinically useful.

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