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A Case of Undifferentiated Shock Due to Probable Voriconazole-Related Primary Adrenal Insufficiency

Year: 2025

Type: article

Abstract: Adrenal insufficiency (AI) can be a rare effect with azole antifungals, classically, ketoconazole. Whether AI can be observed with newer triazole drugs used for treating invasive fungal infections is far less understood. A 65-year-old man taking voriconazole for Aspergillus pneumonia was admitted to the intensive care unit with confusion and shock. He had hyperkalemia, hyponatremia, and refractory hypotension that resolved with high-dose prednisone for gout and withdrawal of voriconazole. He was discharged with a regimen of isavuconazole and 1 week later was found again with a morning cortisol level of 63.48 nmol/L (reference range, 165.60–507.84 nmol/L] and electrolyte derangements, along with symptoms of AI. His symptoms fully resolved with steroid and mineralocorticoid replacement.

Source: Annals of Internal Medicine Clinical Cases

DOI: 10.7326/aimcc.2024.0180

Authors: Kaleena X. Zhang, Clemens Bergwitz

Institution: Yale University

Language: English

Topic: Adrenal Hormones and Disorders

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4408132237