Endocrine consequences of antifungal therapy: A missed entity

With fungal infections rising worldwide, the use of azoles, polyenes, and echinocandins, the mainstay of antifungal therapy has expanded markedly. With broader use, uncommon adverse effects are increasingly being identified. Azoles, the most widely prescribed class of antifungal agents, inhibit several cytochrome P450-dependent steps in human steroidogenesis, leading to disruption of endocrine pathways. Adrenal and gonadal dysfunctions with ketoconazole, and mineralocorticoid excess with posaconazole and itraconazole, are well-documented. Uncommon manifestations, such as voriconazole-induced syndrome of inappropriate antidiuretic hormone secretion or salt-losing nephropathy, and fluoride-related periostitis associated with voriconazole and itraconazole, have also been reported. The adverse reactions may be further influenced by drug interactions with enzyme inducers or inhibitors. Amphotericin B is known to cause electrolyte disturbances due to tubular damage. Echinocandins differ from azoles and polyenes in that they rarely affect endocrine pathways, making them a safer option when endocrine toxicity is a concern. Clinicians must remain vigilant to the endocrine adverse effects and pharmacological interactions of antifungal agents to enable timely recognition and management.