amphotericin-b and Addison-Disease

Detailed studies of Addison's disease resulting from disseminated adrenal histoplasmosis (AH) are not available. We describe the presentation and prognosis of AH and cortisol status before and after antifungal therapy.. Single-centre retrospective hospital-based study of 40 consecutive adults with AH [39 males; age (mean ± SD) 53 ± 11 years] was conducted between 2006 and 2018. The median duration of follow-up was 2.5 years (range 0.2-12 years).. AH was diagnosed by bilateral adrenal enlargement on CT scan and presence of Histoplasma by histology and/or culture of biopsied adrenal tissue. All patients received oral itraconazole and, if required, amphotericin B as per guidelines. ACTH-stimulated serum cortisol (normal > 500 nmol/L) was measured in 38 patients at diagnosis and re-tested after one year of antifungal therapy in 21 patients.. Seventy-three per cent of patients had primary adrenal insufficiency (PAI) and one-third had an adrenal crisis at presentation. HIV antibody was negative in all patients. Of the 29 patients who completed antifungal therapy, 25 (86%) were in remission at last follow-up. Overall, 8 (20%) patients died: three had a sudden death, four had severe histoplasmosis and one died due to adrenal crisis. No patient with PAI became eucortisolemic on re-testing after one year of antifungal therapy. Of the eight patients with normal cortisol at diagnosis, two developed adrenal insufficiency on follow-up.. All patients with AH tested negative for HIV antibody. While patients achieved a high rate of clinical remission after antifungal therapy, overall mortality was significant. Cortisol insufficiency did not normalize despite treatment.

Topics: Addison Disease; Adult; Amphotericin B; Antifungal Agents; Female; Follow-Up Studies; Histoplasma; Histoplasmosis; Humans; Hydrocortisone; Itraconazole; Male; Middle Aged; Prognosis; Retrospective Studies

A 44-year-old man was admitted with symptoms compatible with Addison crisis. Abdominal computer tomography revealed extensive bilateral adrenal abscesses. Histoplasma capsulatum was cultured from a needle aspirate. The patient was HIV-seronegative and had no underlying malignancy. He may have acquired the infection during several stays in endemic areas in the United States, South America and Asia. The case was also remarkable for moderate brain atrophy, thrombosis of the portal and splenic veins and liver cirrhosis caused by alpha-1-antitrypsin deficiency (phenotype MZ). The patient recovered fully under substitution of adrenal hormones and antifungal treatment. He received intravenous amphotericin B (75 mg q24h) for 10 days, followed subsequently by oral treatment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the inflammatory adrenal lesions.

Topics: Abscess; Acute Disease; Addison Disease; Adrenal Gland Diseases; Adult; alpha 1-Antitrypsin Deficiency; Amphotericin B; Histoplasmosis; Humans; Itraconazole; Liver Cirrhosis; Male; Tomography, X-Ray Computed

Topics: Acremonium; Addison Disease; Amphotericin B; Female; Humans; Middle Aged; Mycoses

South American blastomycosis commonly involves the adrenal glands as proved in autopsy series, although clinical adrenocortical insufficiency is infrequently suspected. In 1972, an Ecuadorian man was seen with disseminated paracoccidioidomycosis and Addison's disease documented by low basal steroid levels and lack of response to ACTH therapy. The patient has since been treated with a total dose of 4,000 mg of amphotericin B. He discontinued all steroid replacement therapy for two years but remained asymptomatic. Recent evaluation documented improvement in basal steroid production, particularly mineralocorticoids. Adrenal reserve has also been demonstrated by the response of glucocorticoids to ACTH stimulation. This is the first well documented case in which adrenal reserve was recovered following treatment of granulomatous Addison's disease.

Topics: Addison Disease; Adrenal Cortex Function Tests; Adrenal Glands; Adrenocorticotropic Hormone; Amphotericin B; Humans; Male; Middle Aged; Paracoccidioidomycosis

Reported is the fifth known case of Addison's disease due to adrenal involvement by North American blastomycosis (Blastomyces dermatitidis infection). The fact that amphotericin B therapy precipitated an addisonian crisis suggests that patients with disseminated blastomycosis should have their adrenal function and reserve evaluated before undergoing systemic chemotherapy.

Topics: Addison Disease; Adrenal Glands; Aged; Amphotericin B; Blastomycosis; Humans; Male

Topics: Addison Disease; Adrenal Glands; Amphotericin B; Autopsy; Histoplasma; Histoplasmosis; Humans; Hydrocortisone; Lung; Male; Middle Aged; Oral Manifestations; Sodium Chloride; Thrombophlebitis; Tongue Diseases; Ulcer; Vena Cava, Inferior

Topics: Addison Disease; Adult; Aged; Amphotericin B; Autopsy; Complement Fixation Tests; Female; Histoplasma; Histoplasmosis; Humans; Lung; Male; Middle Aged; Oral Manifestations; Precipitin Tests; Radiography; Skin Tests; Sulfamethoxazole; Tongue; Tongue Diseases; United Kingdom

Topics: Addison Disease; Adolescent; Adult; Amphotericin B; Child; Communicable Disease Control; Female; Follow-Up Studies; Health Facilities; Histoplasma; Histoplasmosis; Humans; Male; Mortality

Topics: Addison Disease; Administration, Oral; Amphotericin B; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Male; Middle Aged; Potassium

Topics: Addison Disease; Adrenal Gland Diseases; Adult; Aged; Amphotericin B; Chronic Disease; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Male; Mechlorethamine; Middle Aged; Mouth Diseases; Oral Manifestations; Tongue Diseases

Topics: Addison Disease; Adrenal Gland Diseases; Adrenal Glands; Adrenal Insufficiency; Amphotericin B; Blastomycosis; Digoxin; Drug Therapy; Granuloma; Humans; Hydrocortisone; Hypoadrenocorticism, Familial; Norepinephrine; Pathology; Prednisone

Topics: Addison Disease; Administration, Cutaneous; Adrenal Insufficiency; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Gentian Violet; Humans; Hypoadrenocorticism, Familial; Hypoparathyroidism; Nystatin; Sweden