Persistent adrenal insufficiency secondary to low-dose ketoconazole therapy

Persistent adrenal insufficiency secondary to ketoconazole therapy has not previously been documented. A case of adrenocortical insufficiency secondary to low-dose (400 mg per day) ketoconazole therapy for blastomycosis is described. Symptomatic adrenal insufficiency was documented on endocrine testing, required physiologic replacement doses of glucocorticoids, and has not been reversible in two years of follow-up. Thus, adrenal insufficiency may be caused by low-dose ketoconazole therapy, and such adrenal insufficiency may have a prolonged course.