The limited availability of ketoconazole for use in suppressing steroidogenesis in Cushing’s disease has been problematic in recent years. This was a problem faced by Burns et al. when treating a patient with a 4mm corticotroph pituitary adenoma whose symptoms recurred 6 months after transsphenoidal surgery.

Medical control was not achieved with metyrapone alone, so ketoconazole (400mg daily) was added with good effect, but became unavailable. Fluconazole is an alternative azole compound used to treat fungal infections, with fewer side effects (particularly hepatotoxicity) than ketoconazole.

The introduction of fluconazole at 200mg daily, and a subsequent increase to 400mg daily, saw medical control achieved. Following external beam radiotherapy, treatment with fluconazole alone was sufficient to achieve biochemical control. The authors propose that it be considered for use in the medical management of Cushing’s disease.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports 2 2016 EDM-15-0115