SAT-450 Exploring Adrenal Insufficiency in a Patient Undergoing Extended Fluconazole Therapy

Abstract Disclosure: S. Duvvuru: None. E. Luna Ceron: None. L. Kattamuri: None. L. Chozet: None. T.M. Bright: None. Background: Fluconazole, an azole antifungal agent is an infrequent cause of adrenal insufficiency which can occur in critically ill patients and those on high-dose fluconazole therapy. Here, we present a case of adrenal insufficiency in a patient undergoing long-term fluconazole therapy, a rare clinical occurrence. Clinical Case: A 51-year-old male with disseminated coccidioidomycosis who has been on fluconazole maintenance therapy (400mg daily) for 10 years was admitted for evaluation of weakness and fatigue for the last 2 months. On physical examination, the patient had notable hyperpigmentation of oral mucosa and the vermilion border of lips. Initial tests were consistent with primary adrenal insufficiency, with significantly reduced morning cortisol level (2.81microg/dl, n 5-25 microg/dl), elevated ACTH (1221 pg/mL, n 9-52 pg/mL), the peak cortisol after ACTH stimulation was low at (3.77 microg/dL, n≥18 microg/dL), plasma renin level was elevated (6.00 ng/ml/hr, n 0.25-5.82 ng/ml/hr) with low aldosterone (<1ng/dl, n 3-6 ng/dl) and 21 hydroxylase antibody typically associated with Addison’s disease was negative. A CT scan of the abdomen and pelvis with contrast revealed bilaterally thickened adrenal glands without any identifiable masses. This finding suggests adrenal insufficiency, more likely attributed to fluconazole use rather than direct damage to the adrenal glands caused by coccidioidomycosis. Upon admission, the patient presented with hypotension and required transfer to the Medical Intensive Care Unit for pressor support. Hydrocortisone 100 mg was initiated thrice daily, improving blood pressure. The patient gradually stabilized hemodynamically and was eventually weaned off pressors. Hydrocortisone was gradually tapered and patient was discharged on a dose of hydrocortisone 20 mg at 8 a.m. and 10 mg at 3 PM and fludrocortisone 0.05 mg daily. Conclusion: This case highlights the importance of monitoring adrenal function in patients on long-term fluconazole therapy and also emphasises that prompt recognition and early treatment of adrenal insufficiency is vital to prevent acute decompensation. Presentation: Saturday, July 12, 2025