Mineralocorticoid hypertension and hypokalaemia induced by posaconazole

Endocrinology, Diabetes & Metabolism Case Reports
Charlotte BoughtonBenjamin C Whitelaw

Abstract

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. Combined hypertension and hypokalaemia are suggestive of mineralocorticoid excess; further investigation is appropriate.If serum aldosterone is suppressed, then further investigation to assess for an alternative mineralocortic...Continue Reading

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Citations

Oct 30, 2019·Mycoses·Alexander F A D SchauwvliegheRoger J M Brüggemann
Aug 14, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Minh-Vu H NguyenGeorge R Thompson
Nov 2, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Adam J Dipippo, Dimitrios P Kontoyiannis
Aug 25, 2020·The Journal of Antimicrobial Chemotherapy·Matthew R DavisGeorge R Thompson
Jan 24, 2021·Molecular and Cellular Endocrinology·Katharina R Beck, Alex Odermatt
Jan 27, 2021·Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research·Royce H JohnsonArash Heidari
Dec 17, 2020·Journal of Fungi·Neil M Ampel

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