Which patient should not receive ketoconazole for Cushing's disease?

Ketoconazole is an antifungal medication that is also used to manage Cushing's disease due to its ability to inhibit cortisol synthesis. However, this drug can significantly affect liver function, leading to potential hepatotoxicity.

A patient with elevated liver function tests is at increased risk when taking ketoconazole, as the drug can exacerbate existing liver issues and lead to serious liver damage. It's critical to assess liver function before initiating treatment with this medication. Elevated liver enzyme levels suggest that the liver is already under stress, which could potentially worsen with the introduction of a hepatotoxic agent like ketoconazole.

In contrast, other patient profiles listed may not present an immediate contraindication to using ketoconazole. While a recent diagnosis of hepatitis C may raise concern, it does not automatically preclude the use of ketoconazole; careful monitoring would be essential if it were prescribed. Fatigue and headaches are common symptoms and may not be directly related to liver function issues, making them less significant concerning ketoconazole's suitability. Therefore, the high concern regarding liver function makes the first patient category the most unsuitable for this treatment.