{"id":9438,"date":"2026-01-24T08:35:20","date_gmt":"2026-01-24T08:35:20","guid":{"rendered":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/the-antiepileptic-drug-carbamazepine-can-cause-adrenal-insufficiency-in-patients-under-hormone-repla\/"},"modified":"2026-01-24T08:35:20","modified_gmt":"2026-01-24T08:35:20","slug":"the-antiepileptic-drug-carbamazepine-can-cause-adrenal-insufficiency-in-patients-under-hormone-repla","status":"publish","type":"post","link":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/the-antiepileptic-drug-carbamazepine-can-cause-adrenal-insufficiency-in-patients-under-hormone-repla\/","title":{"rendered":"The antiepileptic drug carbamazepine can cause adrenal insufficiency in patients under hormone replacement therapy for congenital adrenal hyperplasia"},"content":{"rendered":"
Damiano Gullo,1<\/sup> Rossella Gelsomino,1<\/sup> Ilenia Marturano,1<\/sup> Domenico Restivo,2<\/sup>
Maria Luisa Arpi,1<\/sup> Daniela Leonardi,1<\/sup> Giuseppina Parrinello,1<\/sup> Sebastiano Squatrito1<\/sup> <\/div>\n
1<\/sup>Endocrinology and 2<\/sup>Neurology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Molecular Biomedicine, University of Catania Medical School, Catania, Italy <\/div>\n
\n

Dear Sir,<\/p>\n

Classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OH CAH) is treated with both glucocorticoids (to suppress pituitary ACTH and adrenal androgen production) and mineralocorticoids (to reduce angiotensin II concentrations).<\/p>\n

A 25-year-old man affected by 21-OH CAH and followed at our endocrine clinic since the age of 2 months, after achievement of skeletal maturity, was treated with constant steroid doses of dexamethasone (DEX) 0.50 mg\/day and fludrocortisone up to 0.1 mg\/day, achieving good clinical and biochemical control of the disease. <\/em>After a long period without follow-up visits the patient returned to us complaining of excessive fatigue and difficulty in concentrating. Serum ACTH, 17-OHPG, androstenedione and renin were all increased, suggesting hypoadrenalism. This condition persisted despite the progressive increase in replacement therapy dose. An effect of carbamazepine, started 3 years earlier because of epilepsy, on exogenous steroid metabolism was hypothesized.<\/p>\n

Carbamazepine (200 mg TID) was then discontinued and substituted with levetiracetam (500 mg TID), an antiepileptic drug with different pharmacokinetics characteristics. Hormone levels gradually normalized and at 45 days were all within the normal range (Table 1<\/a>).The patient reported a clear improvement of his symptoms within 5 weeks after drug switch.<\/p>\n

This case highlights the importance of the interaction between steroid medications and drugs that increase cytochrome CYP3A4 activity. Carbamazepine, one of the most widely used and effective drugs for the treatment of epilepsy, is a potent inducer of the hepatic CYP3A4 enzyme activity with the consequence that the metabolism of many xenobiotics, such as DEX and fludrocortisone, is accelerated, lowering their serum concentration. In our patient with 21-OH CAH, the treatment with antiepileptic carbamazepine induced a condition of adrenal insufficiency in spite of increased exogenous steroid dosage. Failure to recognize this interaction may expose treated patients to serious clinical consequences of adrenal insufficiency in the face of trauma, severe illness, surgery, and infectious or neoplastic disease.<\/p>\n

REFERENCES<\/span><\/p>\n

1. Putignano P, Kaltsas GA, Satta MA, Grossman AB, 1998 The effects of anti-convulsant drugs on adrenal function. Horm Metab Res 30: 389-397.<\/p>\n

2. Magnusson MO, Dahl ML, Cederberg J, Karlsson MO, Sandstr\u00f6m R, 2008 Pharmacodynamics of carbamazepine-mediated induction of CYP3A4, CYP1A2, and Pgp as assessed by probe substrates midazolam, caffeine, and digoxin. Clin Pharmacol Ther 84: 52-62.<\/p>\n

<\/p>\n

Address for correspondence:<\/span>
Dr. Damiano Gullo, Endocrinology, Garibaldi-Nesima Hospital,
Catania, 95100 Italy, e-mail: damiano.gullo@poste.it<\/p>\n

Received 14-03-2013, Accepted 13-05-2013 <\/p>\n<\/p><\/div>\n

Download PDF<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Damiano Gullo,1 Rossella Gelsomino,1 Ilenia Marturano,1 Domenico Restivo,2Maria Luisa Arpi,1 Daniela Leonardi,1 Giuseppina Parrinello,1 Sebastiano Squatrito1 1Endocrinology and 2Neurology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Molecular Biomedicine, University of Catania Medical School, Catania, Italy Dear Sir, Classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OH CAH) is treated with both glucocorticoids (to suppress pituitary Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[65,2,14],"tags":[193],"class_list":["post-9438","post","type-post","status-publish","format-standard","hentry","category-volume-12-issue-3","category-journal-articles","category-volume-12","tag-nbsp"],"_links":{"self":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts\/9438","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/comments?post=9438"}],"version-history":[{"count":0,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts\/9438\/revisions"}],"wp:attachment":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/media?parent=9438"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/categories?post=9438"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/tags?post=9438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}