Post Terbinafine Adrenal Gland and Testis Dysfunction that Imitated Fibromyalgia: Case Report

Jasinska D^* and Boczon J

Speciality Hospital in Gorlice, ul. Wegierska, Poland

*Corresponding Author:

Jasinska D
Speciality Hospital in Gorlice, ul. Wegierska
21-38-300-Gorlice, Poland
Tel: +48510819926
E-mail: dorjas34@wp.pl

Received date: January 21, 2016, Accepted date: September 19, 2016, Published date: September 22, 2016

Citation: Jasinska D, Boczon J (2016) Post Terbinafine Adrenal Gland and Testis Dysfunction that Imitated Fibromyalgia: Case Report. J Pain Relief 5:264. doi: 10.4172/2167-0846.1000264

Copyright: © 2016 Jasinska D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

We present the case of a 35 year old patient who suffered from the chronic widespread pain that mimicked fibromyalgia or myopathy, and turned out to be an acquired endocrinological disorder. The Patient was previously treated for fungal skin infection and had been taking terbinafine for 3 months and developed testis and adrenal gland insufficiency.

Introduction

We present the case of 35 year old patient who suffered from the chronic widespread pain that mimced fibromyalgia or myopathy.

Case Report

A Patient aged 35 was admitted to our Neurology Department in order to diagnosed diffuse muscle pain that he suffered from 2 months. He felt constantly tired to a degree that his normal activities were affected. Other symptoms included joint stiffness, sleep disturbance, parestesis, bilateral sciatic nerve and femoral nerve pain. For that reason he took a lot of painkillers as well as antidepressant with analgesic component like venlafaxine but without any relief. His medical history was without meaning except the fact that for last three months he was taking Terbinafine for his skin lesion that was diagnosed as fungal infection.

The results of basic laboratory tests, including blood morphology, CRP level, glucose, CK, urinalysis, chest X-ray examination, liver and kidney function tests, were normal. Standard neurological examination and MR scan of the head was performed as well as lumbar junction with and no changes was found.

Myopathy, maiastenia, multiple sclerosis was excluded and diagnosis of fibromyalgia was proposed. Unfortunately patient started to complain about the low blood pressure symptoms like orthostatic hypotension, dizziness and syncope. His blood pressure lowered to 80/50.

The only results that were beyond the norm were electrolytic level abnormality in blood serum which regarded higher potassium- about 6 and lower sodium level 125. What is more his skin became darker and hyperpigmentation was especially well spotted on patient's palms. These findings induced us to check his adrenal gland hormonal function. Hormones like cortisol were below the norm and ACTH level was very high. Pituitary function was also checked and the hormones excreted- TSH, LH, PRL fitted in the normal range.

What drew our attention to Terbinafine was the fact that one of side effects described in the literature is antianrogenic and antiglucocoritcoid effects. To admit our diagnosis testosterone level was additionally measured and the results was beyond the norm. Once the diagnosis of adrenal gland and testis insuffiency was ascertained hydrocortisone in dosage of 200 mg per day was administered. After three days of therapy muscle pain relived and patient’s blood pressure came back to normal as well as sodium and potassium level in serum.

Discussion

Fibromyalgia is medical condition characterized by chronic widespread pain with a painful response to pressure [1]. Terbinafine blocks the synthesis of the ergo sterol and potently inhibits the activity of several enzymes necessary for the conversion of cholesterol to steroid hormones such as testosterone and cortisol [2-4].

Testosterone induces skeletal muscle hypertrophy by multiple mechanisms, including its effects in modulating the commitment of pluripotent mesenchymal cells. These changes in skeletal muscle lead to improved muscle strength and leg power [5].

Corticoids sustained organism homeostasis and influence on many metabolic functions. They are produced in adrenal cortex and released in response to stress and low blood sugar concentration. Its primary functions in muscle are to increase protein breakdown, inhibit glucose uptake and increase lipolysis (the breakdown of fats). Apart from that mineralocorticoids regulate normal sodium and potassium [6].

While ketoconazole is well known as antiandrogenic and antiglucocoritcoid agent adrenal insufficiency after Terbinafine treatment is reported very rarely. In the one of the study form 6,901 people who has side effects while taking Terbinafine were examined and among them, only 3 have adrenal insufficiency [7]. Patient suffered chronic pain and fatigue that affected his daily life and unable him to work. Our case showed that oral Terbinafine treatment should by cautiously consider and administered only when it's absolutely indispensable.

Conclusion

Hormones like androgens and glucocorticoids have enormous influence on muscle and nerves function and should always be taken into consideration when uncommon or hard to bring under control of neuromuscular symptoms appeared. Terbinafine is rarely associated with antiandrogenic and antiglucocoritcoid side effects therefore our case is worth noticing.

References

1. Ngian GS, Guymer EK, Littlejohn GO (2011) "The use of opioids in fibromyalgia". Int J Rheum Dis 14: 6–11.
2. Finkel R, Cubeddu LX, Clark MA (2009) Pharmacology (4th edn). Lippincott Williams & Wilkins, Baltimore.
3. Kauffman CA (2004) "Introduction to the Mycoses" (22ndedn). In Goldman L, Ausiello, D. Cecil Textbook of Medicine, Philadelphia.
4. Becker KL (2001) Principles and Practice of Endocrinology and Metabolism (3rd edn). Lippincott Williams & Wilkins, USA.
5. Principles and Practice of Endocrinology and Metabolism
6. Herbst KL, Bhasin S (2004) Testosterone action on skeletal muscle. CurrOpinClinNutrMetab Care 7: 271-277.
7. www.ehealthme.com/ds/lamisil/adrenal+insufficiency