More on Osilodrostat for Bilateral Adrenal Hypercortisolism in Primary Aldosteronism

To the Editor: Richa et al. (Nov. 27 issue) 1 recently reported their clinical experience in using osilodrostat, an aldosterone synthase (CYP11B2) and 11β-hydroxylase (CYP11B1) inhibitor, in the treatment of a patient with primary bilateral macronodular adrenal hyperplasia with cosecretion of aldosterone and cortisol. Impressively, osilodrostat therapy led to reductions in the levels of serum aldosterone and urinary free cortisol to below the lower limit of the normal range, resulting in normalization of blood-pressure and serum potassium levels. Nevertheless, the patient’s acceptance of lifelong “medical adrenalectomies” with osilodrostat, as compared with more cost-effective and curative surgical adrenalectomies that do require lifelong . . .