RT Journal
A1 Khosla S, Wolfson JS, Demerjian Z, Godine JE
T1 ADrenal crisis in the setting of high-dose ketoconazole therapy
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1989
FD April 1
VO 149
IS 4
SP 802
OP 804
DO 10.1001/archinte.1989.00390040040007
UL http://dx.doi.org/10.1001/archinte.1989.00390040040007
AB • We describe a patient with type I diabetes mellitus and hypothyroidism who developed frank adrenocortical insufficiency while receiving a high-dose ketoconazole therapy for keratitis caused by Acanthamoeba species. While impaired cortisol responses to corticotropin and mildly symptomatic hypoadrenalism have been described previously with ketoconazole therapy, to our knowledge, this case represents the first documented article of an actual adrenal crisis associated with this drug. Two reasons are postulated for the development of this complication in our patient: high-dose ketoconazole therapy given in divided doses during the day, and a possibly impaired central response to stress because of hypothyroidism. Our article points to the need to monitor patients treated with high-dose ketoconazole for adrenal insufficiency, particularly if associated illnesses are present that may impair an adequate stress response.(Arch Intern Med. 1989;149:802-804)