When monitoring a patient starting treatment with ketoconazole for Cushing's disease, which laboratory values are most critical?

The choice of monitoring AST, ALT, and GGT when a patient begins treatment with ketoconazole for Cushing's disease is particularly important due to the potential hepatotoxicity associated with this medication. Ketoconazole, an antifungal agent that is also used to suppress cortisol production in conditions like Cushing's disease, can lead to liver enzyme elevations, indicating liver stress or damage. Monitoring these liver function tests allows healthcare providers to assess how well the patient's liver is handling the medication and to identify any signs of liver dysfunction early.

Elevations in these enzymes (aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase) can signal the need for further evaluation or intervention, including possible dose adjustments or discontinuation of the drug. Therefore, close observation of these specific laboratory values is crucial in managing the safe administration of ketoconazole, particularly because Cushing’s disease and its treatment can already complicate the patient’s overall metabolic state. This proactive approach helps mitigate the risk of significant liver injury as treatment progresses.