Q: Which antifungal drug can be used as the primary medical treatment in hypercortisolism? - Select one
A) Fluconazole
B) Itraconazole
C) Ketoconazole
D) Miconazole
E Voriconazole
Answer: C
Although hypercortisolism in Cushing syndrome is primarily treated surgically, in a few cases where surgery is not an option, medical treatment is pursued. Ketoconazole is the primary agent in these cases; interestingly, in the United States, it is used off-label to treat hypercortisolism.
Ketoconazole is a racemic mixture of L- and D-form enantiomers and has two targets. First, it inhibits the first step in cortisol biosynthesis, i.e., side-chain cleavage. Second, it inhibits the conversion of 11-deoxycortisol to cortisol. For this reason, it may also decrease the production of other steroid hormones.
#endocrinology
References:
1. Castinetti F, Guignat L, Giraud P, et al. Ketoconazole in Cushing's disease: is it worth a try? J Clin Endocrinol Metab 2014; 99:1623.
2. Viecceli C, Mattos ACV, Costa MCB, de Melo RB, Rodrigues TDC, Czepielewski MA. Evaluation of ketoconazole as a treatment for Cushing's disease in a retrospective cohort. Front Endocrinol (Lausanne). 2022 Oct 7;13:1017331. doi: 10.3389/fendo.2022.1017331. PMID: 36277689; PMCID: PMC9585352.
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