Should we avoid using ketoconazole in patients with severe Cushing’s syndrome and increased levels of liver enzymes?

in European Journal of Endocrinology
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To the Editor,

We read with interest the paper of Young et al. in which the authors recommend avoiding ketoconazole in the treatment of Cushing’s syndrome when patients display increased liver enzymes (>2-fold the upper limit of normal (ULN)) (1).

Severe hypercortisolism is a life-threatening condition and is considered as an endocrine emergency requiring a rapid and dramatic decrease in cortisol levels (2). Ketoconazole and metyrapone, in monotherapy or in association, have been recommended in this instance since they inhibit cortisol synthesis within hours and can normalize cortisol levels within days (2,


     European Society of Endocrinology

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    Evolution of mean levels of liver enzymes and UFC during the first month of ketoconazole administration in nine patients with severe Cushing’s syndrome. ALT, alanine aminotransferase; AST, aspartate aminotransferase; UFC, urinary free cortisol; ULN, upper limit of normal.



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