Endocrine Abstracts

JOINT2107

Background: The malignant adrenocortical carcinoma is an aggressive tumor of the adrenal cortex, with an incidence of between 1 and 2 cases per million population and a peak between the ages of 40 and 50. Rapid management of hypercorticism is essential to prepare for surgical intervention. As Ketoconazole is not available, Fluconazole, another azole antifungal, is a suitable alternative that has been successfully used in our department for another patient with paraneoplastic Cushing’s syndrome, with no adverse effects.

Case presentation: The patient was 31 years old and presented with hypertension complicated by heart failure and a clinical Cushing’s syndrome consisting of truncal obesity, buffalo neck, and purple stretch marks; the hormonal work-up confirmed endogenous hypercorticism. A CT angio scan identified a large left adrenal mass measuring 205 × 191 × 156 mm, with infiltration of the perilesional fat. Further staging via thoraco-abdomino-pelvic CT revealed the presence of pulmonary metastases. Following the successful emergency surgery on injectable Fluconazole for a patient with paraneoplastic Cushing’s syndrome, we opted for fluconazole 400 mg injectable daily, with 24-h urinary free cortisol (UFC) monitoring and liver function tests every 48 hs. After 12 days of treatment, the patient’s UFC levels decreased from 632.5 nmol/24 h to 60 nmol/24 h without any signs of liver damage. Following adrenalectomy, the patient experienced a postoperative adrenal insufficiency with a postoperative UFC of 16.73 nmol/24 h at 7 days after surgery.

Conclusion: This is the second case in our department of successful management of hypercorticism by injectable fluconazole in preparation for surgery. These findings suggest that Fluconazole is a safe and effective alternative to ketoconazole. Further studies involving larger patient populations are needed to fully evaluate its potential as a synthetic anti-cortisolic agent.