Fluconazole and acetazolamide in the treatment of ectopic Cushing's syndrome with severe metabolic alkalosis

[摘要] Cushing’s syndrome (CS) due to ectopic ACTH production accounts for about 10% of all types of CS and is frequentlyassociated with metabolic alkalosis. Treatment of CS involves surgical resection and/or medical therapy to controlhypercortisolism. We present the case of an 80-year-old woman affected by CS due to an unknown cause. The patient hadsevere metabolic alkalosis with refractory hypokalemia. To treat the underlying CS, fluconazole was initiated due tounavailability of ketoconazole. In spite of markedly decreasing cortisol levels, metabolic alkalosis persisted. Treatment ofmetabolic alkalosis with acetazolamide was thus initiated and pH levels successfully lowered. This case report shows thathypercortisolism can be effectively treated with fluconazole in cases where ketoconazole is unavailable or not tolerated andthat persistent severe metabolic alkalosis caused by glucocorticoid excess can be safely and successfully treated withacetazolamide.

[学科分类] 血液学

[关键词] Adult;Female;White;Austria;Pituitary;Pituitary;ACTH;Cortisol;Ectopic Cushing syndrome;Cushing's syndrome;Metabolic alkalosis;Hypokalaemia;Vertigo;Dizziness;Fatigue;Hyperglycaemia;Cortisol;free (24-hour urine);Dexamethasone (high-dose);CRH stimulation;Cortisol (serum);ACTH;MRI;CT scan;Alkaline phosphatase;Fluconazole;Acetazolamide;Oncology;Novel treatment;June;2015