Severe posaconazole-induced glucocorticoid deficiency with concurrent pseudohyperaldosteronism: An unfortunate two-for-one special

Abstract

A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was di-agnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohy-peraldosteronism and severe glucocorticoid deficiency due to posaconazole’s mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.