Which patient should be evaluated for contraindications before receiving ketoconazole for Cushing's disease?

Ketoconazole is an antifungal medication that is also used to treat Cushing's disease due to its ability to inhibit steroidogenesis. An important consideration in administering ketoconazole is its potential hepatotoxicity. Elevated liver function tests indicate that the liver may not function properly, which can increase the risk of adverse effects from the medication.

Before beginning treatment with ketoconazole, patients with elevated liver enzymes need to be thoroughly evaluated. This evaluation may include further liver function tests and a review of the patient’s medical history to determine any underlying liver conditions that might contraindicate the use of the drug. Proper liver function is crucial, as ketoconazole can exacerbate liver issues, leading to severe complications. Therefore, it is essential to assess liver function prior to treatment to ensure the patient's safety.

Other clinical considerations, such as diabetes, controlled hypertension, or anxiety, while still important in the overall care of the patient, do not carry the same potential for significant complications directly associated with ketoconazole treatment as impaired liver function does.