A 37-year-old man with small cell lung carcinoma presents with ectopic ACTH syndrome. Vital signs show BP 168/98 mmHg, HR 102, RR 18, temp 37.2°C. Physical examination reveals central obesity, proximal muscle weakness, and hyperpigmentation. Labs reveal 24-hour urine cortisol 450 mcg (normal <50), morning cortisol 38 mcg/dL, and serum potassium 2.9 mEq/L. He denies recent infections. While awaiting chemotherapy, he is started on a medication dosed at 400 mg daily that inhibits adrenal steroid synthesis but carries risks of hepatotoxicity and gynecomastia. Which drug was prescribed?
- A)Hydrocortisone
- B)Metyrapone
- C)KetoconazoleGABARITO
- D)Fludrocortisone
- E)Dexamethasone
Explicação
Ketoconazole inhibits steroid synthesis and is used off label to rapidly lower cortisol production in endogenous Cushing syndrome. Its antiandrogen effect can cause gynecomastia, and hepatotoxicity is an important adverse effect. Ver explicação completa e trilha adaptativa →