How does ketoconazole work in the treatment of Cushing's disease?

Ketoconazole is primarily an antifungal medication, but it also has significant effects on adrenal steroidogenesis. In the context of Cushing's disease, a condition characterized by excess cortisol production, ketoconazole works by inhibiting steroidogenesis, which ultimately leads to a decrease in cortisol secretion. This mechanism is particularly beneficial in managing Cushing's disease as it addresses the underlying hypercortisolism by lowering the levels of cortisol produced by the adrenal glands.

The drug disrupts the process of cortisol synthesis by interfering with various enzymes involved in steroid production, specifically affecting pathways that lead to cortisol synthesis. This action helps alleviate the symptoms of Cushing's disease, making ketoconazole a useful treatment option when surgery is not suitable or when there is a need for rapid control of cortisol levels.

In contrast to other potential mechanisms, such as stimulating cortisol production, enhancing cortisol metabolism, or inhibiting aldosterone production, ketoconazole's primary role in Cushing's disease is the suppression of cortisol secretion. This effectiveness in blocking cortisol production directly correlates with its use in clinical settings to manage hypercortisolism.