Cushing Syndrome Medication

  • Author: Gail K Adler, MD, PhD; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 22, 2012
 

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

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Adrenal steroid inhibitors

Class Summary

These agents either inhibit key steps in the synthesis of mineralocorticoids and glucocorticoids, or competitively bind glucocorticoid receptors.

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Metyrapone (Metopirone)

 

Inhibitor of endogenous adrenal corticosteroid synthesis. Inhibits 11-B-hydroxylation reaction in the adrenal cortex.

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Ketoconazole (Nizoral)

 

Imidazole broad-spectrum antifungal agent that acts on several of the P450 enzymes, including the first step in cortisol synthesis, cholesterol side-chain cleavage, and conversion of 11-deoxycortisol to cortisol.

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Aminoglutethimide (Cytadren)

 

Inhibits conversion of cholesterol to delta-5-pregnenolone, which, in turn, reduces the production of adrenal glucocorticoids, mineralocorticoids, aldosterone, estrogens, and androgens.

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Mifepristone (Korlym)

 

Mifepristone is an antiprogestational agent, which, at high doses, competitively binds to the glucocorticoid and progesterone receptors. It is indicated to control hyperglycemia secondary to hypercortisolism in adult patients with endogenous Cushing syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery, or are not candidates for surgery.

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Contributor Information and Disclosures
Author

Gail K Adler, MD, PhD  Associate Professor of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School

Gail K Adler, MD, PhD is a member of the following medical societies: American Heart Association and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Frederick H Ziel, MD  Associate Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group

Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

We wish to thank Susanna L Dipp, MD, Fellow, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, for her previous contributions to this entry.

References

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  24. Corcept Therapeutics Incorporated announces FDA approval of Korlym (mifepristone) 300 mg tablets: First and only approved medication for Cushing's Syndrome Patients. Corcept Therapeutics. Available at http://www.corcept.com/news_events/pr_1329524335. Accessed February 21, 2012.

 
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Physical findings in Cushing syndrome.
Diagnosis of Cushing syndrome.
Etiology of Cushing syndrome.
Table. States of Increased and Decreased HPA Activity
States of Increased HPA ActivityStates of Decreased HPA Activity
Chronic stress[9]



Melancholic depression



Anorexia nervosa



Obsessive-compulsive disorder



Panic disorder



Excessive exercise



Chronic active alcoholism



Alcohol and nicotine withdrawal



Diabetes mellitus



Central obesity



Sexual abuse



Hyperthyroidism



Premenstrual tension syndrome



Cushing syndrome



Pregnancy



Adrenal insufficiency



Atypical/seasonal depression



Chronic fatigue syndrome



Fibromyalgia



Hypothyroidism



Nicotine withdrawal



Post glucocorticoid therapy



Post-Cushing syndrome



Postpartum period



Post-chronic stress[9]



Rheumatoid arthritis



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