Thakkar S, Kantroo V, Nagendra L, Dutta D, Kamrul-Hasan ABM, Kalra S, Bhattacharya S. Endocrine consequences of antifungal therapy: A missed entity. World J Clin Cases 2026; 14(2): 117140 [DOI: 10.12998/wjcc.v14.i2.117140]
Corresponding Author of This Article
Saptarshi Bhattacharya, DM, MD, Department of Endocrinology, Indraprastha Apollo Hospitals, Delhi Mathura Road, New Delhi 110076, Delhi, India. saptarshi515@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 16, 2026; 14(2): 117140 Published online Jan 16, 2026. doi: 10.12998/wjcc.v14.i2.117140
Endocrine consequences of antifungal therapy: A missed entity
Simran Thakkar, Viny Kantroo, Lakshmi Nagendra, Deep Dutta, Abul Bashar Mohammad Kamrul-Hasan, Sanjay Kalra, Saptarshi Bhattacharya
Simran Thakkar, Saptarshi Bhattacharya, Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi 110076, Delhi, India
Viny Kantroo, Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, Delhi, India
Lakshmi Nagendra, Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570004, Karnātaka, India
Deep Dutta, Department of Endocrinology, CEDAR Superspeciality Clinic, New Delhi 110075, Delhi, India
Abul Bashar Mohammad Kamrul-Hasan, Department of Endocrinology, Mymensingh Medical College, Mymensingh 2200, Bangladesh
Sanjay Kalra, Department of Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
Author contributions: Thakkar S conducted the literature search; Thakkar S, Nagendra L, and Bhattacharya S took part in manuscript preparation; Kantroo V assisted in the design and definition of intellectual content and reviewed the manuscript for scientific accuracy; Nagendra L provided clinical insights; Nagendra L, Dutta D, Kamrul-Hasan ABM, and Kalra S provided critical review of the manuscript; Dutta D, Kamrul-Hasan ABM, Kalra S, and Bhattacharya S participated in manuscript editing; Kalra S provided clinical expertise; Bhattacharya S conceptualized and contributed to the design of the research and takes responsibility for the integrity of the work as a whole, from inception to publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Saptarshi Bhattacharya, DM, MD, Department of Endocrinology, Indraprastha Apollo Hospitals, Delhi Mathura Road, New Delhi 110076, Delhi, India. saptarshi515@gmail.com
Received: December 1, 2025 Revised: December 15, 2025 Accepted: December 25, 2025 Published online: January 16, 2026 Processing time: 48 Days and 10 Hours
Abstract
With fungal infections rising worldwide, the use of azoles, polyenes, and echinocandins, the mainstay of antifungal therapy has expanded markedly. With broader use, uncommon adverse effects are increasingly being identified. Azoles, the most widely prescribed class of antifungal agents, inhibit several cytochrome P450-dependent steps in human steroidogenesis, leading to disruption of endocrine pathways. Adrenal and gonadal dysfunctions with ketoconazole, and mineralocorticoid excess with posaconazole and itraconazole, are well-documented. Uncommon manifestations, such as voriconazole-induced syndrome of inappropriate antidiuretic hormone secretion or salt-losing nephropathy, and fluoride-related periostitis associated with voriconazole and itraconazole, have also been reported. The adverse reactions may be further influenced by drug interactions with enzyme inducers or inhibitors. Amphotericin B is known to cause electrolyte disturbances due to tubular damage. Echinocandins differ from azoles and polyenes in that they rarely affect endocrine pathways, making them a safer option when endocrine toxicity is a concern. Clinicians must remain vigilant to the endocrine adverse effects and pharmacological interactions of antifungal agents to enable timely recognition and management.
Core Tip: Antifungal drugs can interfere with key endocrine pathways by inhibiting steroidogenic enzymes or through drug interactions that alter glucocorticoid and mineralocorticoid metabolism. Ketoconazole, fluconazole, itraconazole, posaconazole, and voriconazole demonstrate distinct endocrine adverse effects, ranging from adrenal insufficiency and apparent mineralocorticoid excess to reproductive dysfunction, hyponatremia, and fluoride-related periostitis. Amphotericin B primarily induces renal tubular injury and associated electrolyte disturbances, whereas echinocandins rarely affect endocrine function. Recognizing these effects, especially in patients receiving multiple interacting medications, is essential for timely diagnosis and safe therapeutic decision-making.
