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W. Stuart Tucker, Jr, MD; Barbara B. Snell, MD; Donald P. Island; Clark R. Gregg, MD

JAMA. 1985;253(16):2413-2414.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

KETOCONAZOLE, an imidazole antifungal drug, blocks testicular and adrenal steroid synthesis in a dosedependent and time-dependent manner, presumably correlating with serum levels of ketoconazole.^1-5 Although hypogonadism and gynecomastia caused by ketoconazole have been reported, symptomatic hypoadrenalism has not yet been described,^1,4,6 to the best of our knowledge. We report a patient who developed symptoms and signs of hypoadrenalism while receiving an experimentally high daily dose of ketoconazole. The results of serum and urinary steroid measurements confirmed this clinical impression. All symptoms and signs of adrenal insufficiency resolved promptly following discontinuation of ketoconazole therapy.

Methods

A one-hour intravenous adrenocorticotropic hormone (ACTH) (cosyntropin [Cortrosyn]) test,⁷ a 48-hour intravenous ACTH (Cortrosyn) test,⁸ and a metyrapone (Metopirone) test⁹ were performed during ketoconazole therapy and were repeated after its discontinuation.

Report of a Case

A hypertensive 48-year-old black man had an average blood pressure of 140/90 mm Hg with methyldopa (Aldomet), . . . [Full Text PDF of this Article]

Author Affiliations
From the Divisions of Endocrinology (Dr Tucker and Mr Island) and Infectious Diseases (Dr Gregg), Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn. Dr Snell is in private practice in Nashville, Tenn. Dr Tucker is now with The Nalle Clinic, Charlotte, NC.

Footnotes
Read in part before the 83rd annual meeting of the American Society for Microbiology, New Orleans, March 9, 1983.

Reprint requests to Division of Infectious Diseases, Department of Medicine, St Thomas Hospital, PO Box 380, Nashville, TN 37202 (Dr Gregg).

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