Preoperative ketoconazole therapy for adrenocortical carcinoma.

K etoconazole, an imidazole derivative, is a broad-spectrum antifungal agent. The development of gynecomastia in some men receiving ketoconazole fostered research into the drug's inhibitory effects on the production of testosteronel 2 and, subsequently, other steroid hormones.3-5 Ketoconazole has been used in the treatment of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (Cushing's disease and ectopic ACTH syndromes), but there has been little experience with its use in Cushing's syndrome of primary adrenal origin.6 We report a case of adrenocortical carcinoma in which preoperative ketoconazole therapy resulted in short-term clinical improvement.