{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:00:52Z","timestamp":1791806452956,"version":"4.3.4"},"reference-count":26,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,2,9]],"date-time":"2018-02-09T00:00:00Z","timestamp":1518134400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,2,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11\u03b2 hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11\u03b2 hydroxysteroid dehydrogenase type 2 (11\u03b2HSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone. We also suggest that posaconazole may cause cortisol insufficiency. Patients taking posaconazole should therefore be monitored for hypokalaemia, hypertension and symptoms of hypocortisolaemia, at the onset of treatment and on a monthly basis. Treatment with mineralocorticoid antagonists (spironolactone or eplerenone), supplementation of glucocorticoids (e.g. hydrocortisone) or dose reduction or cessation of posaconazole should all be considered as management strategies.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Combined hypertension and hypokalaemia are suggestive of mineralocorticoid excess; further investigation is appropriate.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>If serum aldosterone is suppressed, then further investigation to assess for an alternative mineralocorticoid is appropriate, potentially using urine steroid profiling and\/or serum steroid panelling.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Posaconazole can cause both hypokalaemia and hypertension, and we propose that this is due to two mechanisms \u2013 both 11\u03b2 hydroxylase inhibition and 11\u03b2 HSD2 inhibition.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Posaconazole treatment may lead to cortisol insufficiency, which may require treatment; however, in this clinical case, the effect was mild.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>First-line treatment of this presentation would likely be use of a mineralocorticoid antagonist.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Patients taking posaconazole should be monitored for hypertension and hypokalaemia on initiation and monthly thereafter.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-17-0157","type":"journal-article","created":{"date-parts":[[2018,2,9]],"date-time":"2018-02-09T05:46:46Z","timestamp":1518155206000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":12,"title":["Mineralocorticoid hypertension and hypokalaemia induced by posaconazole"],"prefix":"10.1530","volume":"2018","author":[{"given":"Charlotte","family":"Boughton","sequence":"first","affiliation":[{"name":"1Endocrinology Department of Clinical Biochemistry (Viapath)King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Taylor","sequence":"additional","affiliation":[{"name":"2Department of Clinical Biochemistry (Viapath)King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Ghataore","sequence":"additional","affiliation":[{"name":"2Department of Clinical Biochemistry (Viapath)King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Taylor","sequence":"additional","affiliation":[{"name":"2Department of Clinical Biochemistry (Viapath)King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin C","family":"Whitelaw","sequence":"additional","affiliation":[{"name":"1Endocrinology Department of Clinical Biochemistry (Viapath)King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref191","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.bcp.2017.01.010","article-title":"Inhibition of 11beta-hydroxysteroid dehydrogenase 2 by the fungicides itraconazole and posaconazole","volume":"130","year":"2017","journal-title":"Biochemical Pharmacology"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1365-2265.1986.tb01662.x","article-title":"Effects of high dose ketoconazole therapy on the main plasma testicular and adrenal steroids in previously untreated prostatic cancer patients","volume":"24","year":"1986","journal-title":"Clinical Endocrinology"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1210\/jcem-44-5-924","article-title":"Evidence for an unidentified steroid in a child with apparent mineralocorticoid hypertension","volume":"44","year":"1977","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref31","first-page":"e00760","article-title":"In vivo 11\u03b2-hydroxysteroid dehydrogenase inhibition in Posaconazole-Induced Hypertension and Hypokalemia 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