Download PDF
CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1802640
Case Report

Itraconazole Treatment Unmasking Secondary Adrenal Insufficiency in a Case of Burnt-out Acromegaly

Alma Mostafa
1   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
,
Fazeela Ansari
1   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
,
Faizal Ahamed
2   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Adrenal insufficiency is a serious condition marked by inadequate production of steroid hormones, leading to a range of systemic symptoms and potential complications if left unrecognized. It can be categorized as primary, where pathology lies in adrenal glands themselves, or secondary, stemming from lack of adrenocorticotropic hormone-mediated stimulation from the pituitary gland. Various factors, including infection, stress, and certain medications, can precipitate or worsen adrenal insufficiency in susceptible patients. Azole antifungals have been known to interfere with adrenal hormone production and have been linked to cases of adrenal insufficiency. This case report presents a detailed scenario in which an adrenal crisis was precipitated by the use of itraconazole in a patient with no history of adrenal insufficiency, illustrating the complex interaction between medication effects and underlying endocrine issues.

Keywords

adrenal insufficiency - acromegaly - empty sella - IGF-1 - itraconazole

Financial Disclosure

None.


Patient Consent

The authors confirm that they have obtained written informed consent from the patient to publish the case and photos.


Ethical Approval

No prior ethical approval is required for single-case reports and small-case series, provided the patient or guardian provides informed consent.




Publication History

Article published online:
21 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Husebye ES, Pearce SH, Krone NP, Kämpe O. Adrenal insufficiency. Lancet 2021; 397 (10274): 613-629
    CrossrefPubMedSearch in Google Scholar
  • 2 Chanson P, Guignat L, Goichot B. et al. Group 2: adrenal insufficiency: screening methods and confirmation of diagnosis. Ann Endocrinol (Paris) 2017; 78 (06) 495-511
    CrossrefPubMedSearch in Google Scholar
  • 3 Benitez LL, Carver PL. Adverse effects associated with long-term administration of azole antifungal agents. Drugs 2019; 79 (08) 833-853
    CrossrefPubMedSearch in Google Scholar
  • 4 Xie SL, Zhu X, Gao N. et al. Genetic variations of CYP3A4 on the metabolism of itraconazole in vitro. Food Chem Toxicol 2023; 181: 114101
    CrossrefPubMedSearch in Google Scholar
  • 5 Bishnoi A, Narang T, Das L. et al. Itraconazole-induced adrenal insufficiency in a patient with exogenous Cushing's syndrome. Indian J Dermatol, Venereol Leprol 2023; 30: 1-2
    Search in Google Scholar
  • 6 Izizag BB, Ngandu A, Mbiso DL. Empty sella syndrome: a case report [in French]. Pan Afr Med J 2019; 33: 317
    PubMedSearch in Google Scholar
  • 7 Ucciferro P, Anastasopoulou C. Empty Sella Syndrome. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024
    Search in Google Scholar