Influence of the Antimycotic Drug Itraconazole on Plasma Cortisol Levels and Blood Pressure in a Patient with Burnout Syndrome

Abstract

Burnout is a syndrome that is increasingly common nowadays. It is associated with reduced work efficiency and chronic exhaustion. The main cause of burnout is continuous stress at work and not enough rest. The main system involved in the pathogenesis of burnout is the hypothalamic–pituitary–adrenocortical axis with the final substrate of the glucocorticoid hormone cortisol. Therefore, in patients with burnout syndrome, the morning plasma cortisol levels are elevated, but there is no significant change in its evening values. This correlates with an increase in blood pressure, weight gain, muscle weakness, low immunity, etc. The following case report is about the unusual effect of the antifungal drug itraconazole on the circadian rhythm of the plasma cortisol levels, as well as on the blood pressure in patient with burnout syndrome. One month of peroral application of 100 mg itraconazole every day reduces the morning plasma cortisol levels to the greatest extent (by approximately 37%) rather than the evening cortisol levels (by circa 17.5%). The decrease in the mean ambulatory systolic and diastolic blood pressure is also not uniform (it is stronger in diastolic – 27% than in systolic – 17%).