When the Cure Becomes the Cause: Adrenal Insufficiency in Cushing's Management

    October 2025 in “ Journal of the Endocrine Society ”
    Jagathi Kalluru, Sachin Majumdar
    TLDR Careful dosing and monitoring are crucial to prevent adrenal insufficiency when using ketoconazole for Cushing's disease.
    The document discusses the case of a 69-year-old woman with severe hypercortisolism who developed adrenal insufficiency after starting ketoconazole, a treatment for Cushing’s syndrome. Despite initial high cortisol levels, ketoconazole led to a rapid drop in cortisol, causing hypotension and altered mental status. The treatment was adjusted, but the patient eventually passed away due to other health complications. The study highlights the risk of acute adrenal insufficiency with ketoconazole, especially in patients with prior glucocorticoid exposure, and suggests careful dose titration or a block and replace strategy to prevent such outcomes.
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