Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prostate biopsy was carried out in a 53-year-old male outpatient with disseminated prostatic carcinoma. Two days later, he was admitted with severe acute anaemia (haemoglobin: 48 g.l-1) and macroscopic haematuria. Biological investigations revealed a disseminated intravascular coagulation (DIC). Symptomatic treatment was undertaken (transfusion of packed red blood cells, platelets, fresh frozen plasma and fibrinogen). However, the patient's condition worsened, and he was admitted to the intensive care unit 48 h later. Despite appropriate symptomatic treatment, the patient's condition continued to worsen. The prostatic origin of this condition was therefore suspected, and anti-androgenic treatment was started on day 9 (1,200 mg.day-1 ketoconazole and 2,000 mg.day-1 sodium fosfestrol). Within 48 h, the patient had began to recover in quite a spectacular manner. Ketoconazole starts blocking steroid synthesis within 4 h of giving it. This treatment can be used until oestrogen therapy starts having an effect (about one week). The low levels of testosterone in this case, before starting treatment, suggest that ketoconazole acted on the DIC by a possible cytotoxic effect on the carcinomatous cells.
 ...
PMID:[Favorable outcome of neoplastic disseminated intravascular coagulation treated with ketoconazole and estrogen derivative]. 192 64

The disseminated intravascular coagulation syndrome is an untoward side effect of metastatic adenocarcinoma of the prostate. In addition to appropriate replacement of blood, platelets and clotting factors, prompt treatment of the prostatic carcinoma is required to correct the underlying pathophysiological defect. Ketoconazole is the ideal method for hormonal manipulation for patients with life-threatening complications of prostatic carcinoma (disseminated intravascular coagulation and acute paraparesis/paraplegia) because of its prompt onset of action in decreasing circulating concentrations of androgens to castrate levels. Serum testosterone levels are castrate within 48 hours of the initiation of therapy with ketoconazole as opposed to a minimum of 10 to 14 days with estrogens. A patient with spontaneous bleeding from disseminated intravascular coagulation was treated with 400 mg. ketoconazole every 8 hours and bleeding stopped within 48 hours. Ketoconazole is particularly valuable when a prompt therapeutic response is needed and orchiectomy is contraindicated because of bleeding diathesis (as in disseminated intravascular coagulation), delay in histological confirmation (as in acute paraparesis/paraplegia) or patient reluctance to undergo castration.
 ...
PMID:The use of ketoconazole in the emergency management of disseminated intravascular coagulation due to metastatic prostatic cancer. 357 56

Ketoconazole has been used with success to treat disseminated intravascular coagulation and acute spinal cord compression syndromes associated with metastatic prostatic adenocarcinoma. It effects prompt, reversible medical castration, making it especially useful as empiric therapy when histologic diagnosis is delayed but prostate cancer is suspected. Side effects are usually limited to asthenia, nausea, diarrhea, and gynecomastia, but a theoretical risk of adrenal suppression exists. We report a case of fulminant adrenal crisis precipitated by ketoconazole given on a 6-hour dosing schedule in a patient with nerve root compression secondary to prostatic metastases. Through a review of the literature, we attempt to provide a better understanding of the use and potential dangers associated with ketoconazole therapy.
 ...
PMID:Ketoconazole-induced adrenal crisis in a patient with metastatic prostatic adenocarcinoma: case report and review of the literature. 914 92