When the Cure Becomes the Cause: Adrenal Insufficiency in Cushing's Management
October 2025
in “
Journal of the Endocrine Society
”
Studysummary In this case study, a 69-year-old woman with severe hypercortisolism developed acute adrenal insufficiency after starting ketoconazole treatment, highlighting the need for cautious dosing and close monitoring of adrenal function, particularly in patients with prior glucocorticoid exposure. Our plain-language summary of this paper — not a Tressless recommendation.
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.
