January - March 2015, Volume 11, Issue 1

Ghervan CM, Nemes C, Valea A, Silaghi A, Georgescu CE, Ghervan L

Ketoconazole Treatment in Cushing’s Syndrome – Results of a Tertiary Referral Center in Romania

Acta Endo (Buc) 2015, 11 (1): 46-54
doi: 10.4183/aeb.2015.46

Introduction. First election treatment in Cushing’s syndrome is the surgical therapy (pituitary or adrenal). Pharmacotherapy is used: before surgery, when the surgery was ineffective, in association with radiotherapy or in cases of refuse or contraindications for surgery. Aim of the study. Testing the effectiveness and safety of Ketoconazole treatment in patients with Cushing’s syndrome. Methods. We studied 12 patients with Cushing’s syndrome treated with Ketoconazole between 2010 and 2013. We followed cortisol levels before and during treatment, the doses of Ketoconazole and the time required for normalization of cortisol, “the escape syndrome” and the adverse effects. Results. Eleven (91,66%) patients had ACTH – dependent Cushing’s syndrome. The mean basal cortisol before initiation of the therapy was 404.4 ± 71 ng/ml. Two thirds (eight) patients presented a normalization of serum cortisol levels with 300-800 mg Ketoconazole/day, during a mean of 8.5 weeks. Only one patient presented an “escape syndrome” and one presented adrenal insufficiency. None of the patients showed significant side effects under the treatment. Conclusions. Ketoconazole therapy is well tolerated and is effective in most patients with Cushing’s syndrome even in long term use. The resistance and the escape from the effect of the treatment is possible, but rare, patients requiring close monitoring during therapy.

Keywords: Cushing’s syndrome, Ketoconazole, adrenalectomy.

Correspondence: Cristina Mariana Valeria Ghervan MD, Department of Endocrinology, University of Medicine and Pharmacy,3 Pasteur street, Cluj-Napoca, Cluj, 400349, Romania, E-mail: cghervan@yahoo.com