KETOCONAZOLE-INDUCED ADRENAL CRISIS IN A PATIENT WITH METASTATIC PROSTATIC ADENOCARCINOMA - CASE-REPORT AND REVIEW OF THE LITERATURE

Ketoconazole has been used with success to treat disseminated intravas cular coagulation and acute spinal cord compression syndromes associat ed with metastatic prostatic adenocarcinoma. It effects prompt, revers ible medical castration, making it especially useful as empiric therap y when histologic diagnosis is delayed but prostate cancer is suspecte d. Side effects are usually limited to asthenia, nausea, diarrhea, and gynecomastia, but a theoretical risk of adrenal suppression exists, W e report a case of fulminant adrenal crisis precipitated by ketoconazo le given on a 6-hour dosing schedule in a patient with nerve root comp ression secondary to prostatic metastases. Through a review of the lit erature, we attempt to provide a better understanding of the use and p otential dangers associated with ketoconazole therapy. (C) 1997, Elsev ier Science Inc.