We report 29 years old female with recurrence of adrenal carcinoma and hypercortisolism secondary to HCG responsive adrenal carcinoma.which has been surgically excised in 2003 following the birth of a live infant at 28 weeks gestation.
A year latter she presented with a tenderness over the right rib cage and had CT scan which showed metastases at the liver and right renal bed.
Hypercortisolism was confirmed biochemicaly with a 24 hour urinary free cortisol of 2993 nmols/24hr, 9:00am serum cortisol of 1201 nmol and ACTH suppressed below 10 pg/ml.
Ketoconazole, the recommended first line agent for suppressing enhanced glucocorticoid production in Cushing syndrome due to arenal carcinoma was not available in Ireland initially.
Thus we discussed with the patient the option of Fluconazole, which was available at the hospital pharmacy.
Following agreement Fluconazole was commenced at a dose of 200 mg once daily. Thereafter it was discontinued after Ketoconazole became available, but reinstated as per the patient wishes as she felt less nauseous with Fluconazole.
Results: Cortisol showed sustained normalization with both drugs.
This case report demonstrates that the antifungal azol-derative Fluconazole may be as effective as Ketoconazol in the treatment of hypercortisolism of Cushings syndrome and may be preferred to Ketoconazole due to better tolerability.