A 37-year-old man with small cell lung carcinoma presents with ectopic ACTH production causing severe hypercortisolism. Vital signs show BP 168/98 mmHg, HR 102/min, RR 18/min, temp 37.2°C. Laboratory studies reveal 24-hour urine free cortisol 892 mcg/day (normal <50) and elevated ACTH 156 pg/mL. He denies recent infections. While awaiting definitive cancer treatment, he is started on a medication that inhibits 11β-hydroxylase and carries risks of hepatotoxicity and gynecomastia. Which drug was most likely prescribed?
- A)Hydrocortisone
- B)Fludrocortisone
- C)Metyrapone
- D)Dexamethasone
- E)KetoconazoleGABARITO
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 →