Use of ketoconazole in the treatment of a virilizing adrenocortical carcinoma.

Abstract

Ketoconazole, an oral antimycotic agent, is known to have a potent inhibitory effect on adrenal steroid production. It was given at a dose of 1200 mg/day to a 52-year-old female patient with a virilizing adrenocortical carcinoma in order to achieve better metabolic control pre-operatively. Together with a rapid normalisation of hypertension and hyperglycemia, a dramatic fall was noticed in serum and urinary adrenal steroids after a few days. Levels of total testosterone (20 nmol/l), androstenedione (greater than 35 nmol/l) and DHEA-sulphate (greater than 28 nmol/l) fell to normal levels in 6 days. By contrast, levels of 17-OH-progesterone (30 nmol/l) and progesterone (2.45 nmol/l) increased slightly, indicating inhibition of adrenal 17,20-lyase. Cortisol (620 nmol/l at 08.00 h) fell to very low levels (50 nmol/l) on day 6 of the trial. We conclude that ketoconazole is very effective in suppression of adrenal tumoural steroidogenesis and merits consideration in pre-operative use. We warn against dangerous hypoadrenalism which seems to occur earlier in tumoural than in normal adrenal metabolism.

• Authors: J A Verhelst, P Druwé, P van Erps, L J Denis, C Mahler
• Journal: Acta endocrinologica (Acta Endocrinol (Copenh)) Vol. 121 Issue 2 Pg. 229-34 (Aug 1989) ISSN: 0001-5598 [Print] Denmark
• PMID: 2773622 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Gonadal Steroid Hormones
• Ketoconazole

Topics

• Adrenal Cortex Hormones (metabolism)
• Adrenal Cortex Neoplasms (drug therapy, metabolism)
• Carcinoma (drug therapy, metabolism)
• Female
• Gonadal Steroid Hormones (metabolism)
• Hirsutism (drug therapy, metabolism)
• Humans
• Ketoconazole (therapeutic use)
• Middle Aged