Endocrine Abstracts

Introduction: Adrenal insufficiency is characterized by inadequate ¬glucocorticoid production owing to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation. Patients can present with an insidious onset of symptoms, or acutely in adrenal crisis, which requires prompt recognition and treatment. Chronic glucocorticoid therapy is the most common cause of adrenal insufficiency. We present a case with an adrenal insufficiency caused by Itraconazole.

Clinical case: A 48 year old lady presented with several weeks of tiredness, extreme fatigue and lethargy and these symptoms affecting her daily quality of life. She has Type 1 Diabetes and blood glucose control within target range with HbA1C of 55 mmol/mol and she also experienced frequent episodes of Hypoglycemia without changes in diet or Insulin regimen. Other health problems is bronchial asthma and aspergilloma on Itraconazole for several months. In view of her symptoms, we arranged early morning serum cortisol (14 nmol/l), Aldosterone (< 103 pmol/l) and plasma renin (15.2 mIU/l) and these results indicate adrenal failure. She was started on Hydrocortisone 10 mg + 5 mg + 5 mg, which showed significant improvement in her symptoms within few days and she noted significant improvement in her quality of life and she had no further hypoglycemic symptoms.

In Conclusion: This case indicates the potential side effects of Itraconazole in patients with aspergilloma causing adrenal suppression and early recognition of the symptoms of adrenal failure is extremely important to avoid patients suffering from such symptoms and to avoid delaying the diagnosis.