DAVID N. ORTH, MD., F.A.C.P.
A recent paper in the British Medical Journal (1) has recommended the use of metyrapone (Metopirone®; 2-methyl-1,2-bis(3-pyridyl)-1-propanone) for long-term treatment of patients with pituitary ACTH-dependent Cushing's syndrome (bilateral adrenal hyperplasia). Metyrapone inhibits the final step in adrenal steroid biosynthesis—the conversion of biologically inactive 11-deoxycortisol to cortisol (2). Metyrapone and aminoglutethimide (Elipten®; α-ethyl-α-p-aminophenylglutarimide), an agent that blocks the first step in steroid biosynthesis (3), have long been used to reduce hypercortisolism associated with adrenocortical tumors or ectopic ACTH syndrome (4-6); the only novelty in the British report lies in the use of such agents in Cushing's disease. What is the pathophysiology
ORTH DN. Metyrapone Is Useful Only as Adjunctive Therapy in Cushing's Disease. Ann Intern Med. ;89:128–130. doi: 10.7326/0003-4819-89-1-128
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Published: Ann Intern Med. 1978;89(1):128-130.
Adrenal Disorders, Endocrine and Metabolism.
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