Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special

Alejandro Villar-Prados; Julia J Chang; David A Stevens; Gary K Schoolnik; Samantha X Y Wang

doi:10.3390/jof7080620

Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special

J Fungi (Basel). 2021 Jul 30;7(8):620. doi: 10.3390/jof7080620.

Authors

Alejandro Villar-Prados¹, Julia J Chang², David A Stevens^{3

4}, Gary K Schoolnik³, Samantha X Y Wang⁵

Affiliations

¹ Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
² Division of Endocrinology, Metabolism, and Gerontology, Stanford University School of Medicine, Stanford, CA 94305, USA.
³ Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
⁴ California Institute of Medical Research, San Jose, CA 95128, USA.
⁵ Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.

Abstract

A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole's mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.

Keywords: 11β-hydroxylase; coccidioidomycosis; hypokalemia; posaconazole; pseudohyperaldosteronism.

Publication types

Case Reports