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Fluconazole, with similar antifungal properties, is being investigated as a potentially safer alternative for managing CS. This study aims to evaluate the efficacy and safety of fluconazole in patients with CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective study evaluated a total of 22 patients with CS, including 12 with Cushing\u2019s disease (CD), 3 with adrenal Cushing\u2019s syndrome (ACS), and 7 with ectopic Adrenocorticotropic hormone (ACTH) syndrome. Fluconazole was administered orally, ranging from 112.5 to 450\u2009mg daily, with the duration varying from 2\u2009weeks to over 5\u2009years. The efficacy of fluconazole was assessed by changes in 24-hour urinary free cortisol (24-h UFC) levels. Additionally, hepatic safety was assessed by monitoring changes in alanine aminotransferase (ALT) levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Following fluconazole treatment, 24-h UFC levels significantly decreased from 717.6\u2009\u00b1\u20091219.4 to 184.1\u2009\u00b1\u2009171.8\u2009\u00b5g\/day (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.035). ALT levels showed an increase from 38.5\u2009\u00b1\u200928.4 to 56.5\u2009\u00b1\u200947.8\u2009U\/L, though this change was not statistically significant (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.090). ALT levels exceeding the upper limit of normal range (ULN) were observed in 12 patients (54.5%), with only 4 patients (18.2%) showing ALT levels more than three times the ULN. Out of 10 patients who received treatment for over 1\u2009year, 5 patients (50.0%) experienced a recurrence, with 24-h UFC levels more than 1.5 times the ULN within 3 to 12\u2009months after fluconazole treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Fluconazole effectively reduces hypercortisolism in patients with CS without significant liver injury, suggesting it as a viable therapeutic option for CS. While some cases have shown treatment escape, more studies are required to confirm the long-term efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20420188251372275","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T10:12:03Z","timestamp":1761041523000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical efficacy and safety of fluconazole treatment in patients with Cushing\u2019s syndrome"],"prefix":"10.1177","volume":"16","author":[{"given":"Tang-Yi","family":"Liao","sequence":"first","affiliation":[{"name":"Section of Endocrinology and Metabolism, Department of Medicine, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital, Chiayi, Taiwan"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Jui","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chii-Min","family":"Hwu","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-790X","authenticated-orcid":false,"given":"Liang-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0125"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1942"},{"issue":"1","key":"e_1_3_4_4_2","first-page":"117","article-title":"Incidence and late prognosis of Cushing\u2019s syndrome: a population-based study","volume":"86","author":"Lindholm J","year":"2001","unstructured":"Lindholm J, Juul S, J\u00f8rgensen JO, et al. 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