Posaconazole-induced hypertension due to inhibition of 11β-hydroxylase and 11β-hydroxysteroid dehydrogenase 2

George R. Thompson, Katharina R. Beck, Melanie Patt, Denise V. Kratschmar, Alex Odermatt

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


We describe two cases of hypertension and hypokalemia due to mineralocorticoid excess caused by posaconazole treatment of coccidioidomycosis and rhinocerebral mucormycosis infections, respectively. Clinical laboratory evaluations, including a comprehensive analysis of blood and urine steroid profiles, revealed low renin and aldosterone and indicated as the underlying mechanism primarily a block of 11β-hydroxylase activity in patient 1, whereas patient 2 displayed weaker 11β-hydroxylase but more pronounced 11β-hydroxysteroid dehydrogenase 2 inhibition. The results show that both previously suggested mechanisms must be considered and emphasize significant interindividual differences in the contribution of each enzyme to the observed mineralocorticoid excess phenotype. The mineralocorticoid symptoms of patient 1 resolved after replacement of posaconazole therapy by isavoconazole, and posaconazole dosage de-escalation ameliorated the effects in patient 2. By providing a thorough analysis of the patients' blood and urine steroidmetabolites, this report adds further evidence for two individually pronounced mechanisms of posaconazole-induced hypertension and hypokalemia. The elucidation of the factors responsible for the individual phenotype warrants further research.

Original languageEnglish (US)
Pages (from-to)1361-1366
Number of pages6
JournalJournal of the Endocrine Society
Issue number7
StatePublished - Jul 2019
Externally publishedYes


  • 11β-hydroxylase
  • 11β-hydroxysteroid dehydrogenase
  • Hypertension
  • Hypokalemia
  • Mineralocorticoid excess
  • Posaconazole

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Posaconazole-induced hypertension due to inhibition of 11β-hydroxylase and 11β-hydroxysteroid dehydrogenase 2'. Together they form a unique fingerprint.

Cite this