**Question:** Which of the following antifungal used in treatment of Cushing syndrome is correct?

A. Amphotericin B
B. Fluconazole
C. Itraconazole
D. Voriconazole

**Core Concept:** Cushing syndrome is a condition caused by prolonged exposure to glucocorticoids, leading to adrenal insufficiency and symptoms like weight gain, hypertension, diabetes, and easy bruising. Antifungal medications are used as an off-label treatment for Cushing syndrome due to their potential to suppress cortisol production by inhibiting the enzyme CYP11B, which is involved in cortisol synthesis.

**Why the Correct Answer is Right:** Amphotericin B is a polyene antifungal medication that has been used to treat Cushing syndrome. It acts by inhibiting the synthesis of ergosterol, a crucial sterol component in fungal cell membranes. Due to its immunosuppressive effects, amphotericin B can indirectly suppress cortisol production by reducing adrenocorticotropic hormone (ACTH) release from the pituitary gland.

**Why Each Wrong Option is Incorrect:**

B. Fluconazole: A triazole antifungal medication that inhibits sterol synthesis in fungi. However, it does not have a significant effect on cortisol synthesis, making it an incorrect choice for treating Cushing syndrome.

C. Itraconazole: Another triazole antifungal medication, similar to fluconazole, itraconazole does not significantly suppress cortisol production. It is not an effective treatment for Cushing syndrome.

D. Voriconazole: A triazole antifungal medication, voriconazole does not have a significant impact on cortisol synthesis. It is not an appropriate treatment for Cushing syndrome.

**Clinical Pearl:** Amphotericin B is the only antifungal medication among the options that has been used to treat Cushing syndrome. However, its immunosuppressive effects make it a suboptimal choice due to the increased risk of infections and nephrotoxicity. A more targeted therapy, such as ketoconazole or metyrapone, is typically preferred for the treatment of Cushing syndrome.