Fluconazole and acetazolamide in the treatment of ectopic Cushing's syndrome with severe metabolic alkalosis

Endocrinology, Diabetes & Metabolism Case Reports

article

Verena Schwetz¹  Felix Aberer¹  Claudia Stiegler¹  Thomas R Pieber¹  Barbara Obermayer-Pietsch¹  Stefan Pilz¹ 

[1] Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz

关键词: Adult;    Female;    White;    Austria;    Pituitary;    Pituitary;    ACTH;    Cortisol;    Ectopic Cushing syndrome;    Cushing's syndrome;    Metabolic alkalosis;    Hypokalaemia;    Vertigo;    Dizziness;    Fatigue;    Hyperglycaemia;    Cortisol;    free (24-hour urine);    Dexamethasone (high-dose);    CRH stimulation;    Cortisol (serum);    ACTH;    MRI;    CT scan;    Alkaline phosphatase;    Fluconazole;    Acetazolamide;    Oncology;    Novel treatment;    June;    2015;   

DOI  :  10.1530/EDM-15-0027

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

Cushing’s syndrome (CS) due to ectopic ACTH production accounts for about 10% of all types of CS and is frequentlyassociated with metabolic alkalosis. Treatment of CS involves surgical resection and/or medical therapy to controlhypercortisolism. We present the case of an 80-year-old woman affected by CS due to an unknown cause. The patient hadsevere metabolic alkalosis with refractory hypokalemia. To treat the underlying CS, fluconazole was initiated due tounavailability of ketoconazole. In spite of markedly decreasing cortisol levels, metabolic alkalosis persisted. Treatment ofmetabolic alkalosis with acetazolamide was thus initiated and pH levels successfully lowered. This case report shows thathypercortisolism can be effectively treated with fluconazole in cases where ketoconazole is unavailable or not tolerated andthat persistent severe metabolic alkalosis caused by glucocorticoid excess can be safely and successfully treated withacetazolamide.

【 授权许可】

CC BY-NC-ND