Mineralocorticoid hypertension and hypokalaemia induced by posaconazole
We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | Echo Research and Practice |
| Online Access: | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0157 |
| _version_ | 1818248753412308992 |
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| author | Charlotte Boughton David Taylor Norman Taylor Benjamin C Whitelaw Lea Ghataore |
| author_facet | Charlotte Boughton David Taylor Norman Taylor Benjamin C Whitelaw Lea Ghataore |
| author_sort | Charlotte Boughton |
| collection | DOAJ |
| description | We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11β hydroxysteroid dehydrogenase type 2 (11βHSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone. We also suggest that posaconazole may cause cortisol insufficiency. Patients taking posaconazole should therefore be monitored for hypokalaemia, hypertension and symptoms of hypocortisolaemia, at the onset of treatment and on a monthly basis. Treatment with mineralocorticoid antagonists (spironolactone or eplerenone), supplementation of glucocorticoids (e.g. hydrocortisone) or dose reduction or cessation of posaconazole should all be considered as management strategies. |
| first_indexed | 2024-12-12T15:25:36Z |
| format | Article |
| id | doaj.art-5a1d20660524493592f66bdc8ab62a90 |
| institution | Directory Open Access Journal |
| issn | 2055-0464 2055-0464 |
| language | English |
| last_indexed | 2024-12-12T15:25:36Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Echo Research and Practice |
| spelling | doaj.art-5a1d20660524493592f66bdc8ab62a902022-12-22T00:20:16ZengBMCEcho Research and Practice2055-04642055-04642018-02-01111510.1530/EDM-17-0157Mineralocorticoid hypertension and hypokalaemia induced by posaconazoleCharlotte Boughton0David Taylor1Norman Taylor2Benjamin C Whitelaw3Lea Ghataore4Endocrinology Department, King’s College Hospital NHS Foundation Trust, London, UKDepartment of Clinical Biochemistry (Viapath), King’s College Hospital NHS Foundation Trust, London, UKDepartment of Clinical Biochemistry (Viapath), King’s College Hospital NHS Foundation Trust, London, UKDepartment of Clinical Biochemistry (Viapath), King’s College Hospital NHS Foundation Trust, London, UKEndocrinology Department, King’s College Hospital NHS Foundation Trust, London, UKWe describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11β hydroxysteroid dehydrogenase type 2 (11βHSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone. We also suggest that posaconazole may cause cortisol insufficiency. Patients taking posaconazole should therefore be monitored for hypokalaemia, hypertension and symptoms of hypocortisolaemia, at the onset of treatment and on a monthly basis. Treatment with mineralocorticoid antagonists (spironolactone or eplerenone), supplementation of glucocorticoids (e.g. hydrocortisone) or dose reduction or cessation of posaconazole should all be considered as management strategies.https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0157 |
| spellingShingle | Charlotte Boughton David Taylor Norman Taylor Benjamin C Whitelaw Lea Ghataore Mineralocorticoid hypertension and hypokalaemia induced by posaconazole Echo Research and Practice |
| title | Mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| title_full | Mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| title_fullStr | Mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| title_full_unstemmed | Mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| title_short | Mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| title_sort | mineralocorticoid hypertension and hypokalaemia induced by posaconazole |
| url | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0157 |
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