Metyrapone Is Useful Only as Adjunctive Therapy in Cushing's Disease

Editorials1 July 1978Metyrapone Is Useful Only as Adjunctive Therapy in Cushing's DiseaseDAVID N. ORTH, MD., F.A.C.P.DAVID N. ORTH, MD., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-89-1-128 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA recent paper in theBritish 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...References1. JEFFCOATEREESTOMLINJONESEDWARDSBESSER WLSACG: Metyrapone in long-term management of Cushing's disease. Br Med J 2:215-217, 1977 CrossrefMedlineGoogle Scholar2. LIDDLEISLANDLANCEHARRIS GDEA: Alterations of adrenal steroid patterns in man resulting from treatment with a chemical inhibitor of 11β-hydroxylation. J Clin Endocrinol Metab 18:906-912, 1958 CrossrefMedlineGoogle Scholar3. FISHMANLIDDLEISLANDFLEISCHERKÜCHEL LGDNO: Effects of amino-glutethimide on adrenal function in man. J Clin Endocrinol Metab 27:481-490, 1967 CrossrefMedlineGoogle Scholar4. STEELBAERGADAMS KRD: Cushing's syndrome in association with a carcinoid tumor of the lung. J Clin Endocrinol Metab 27:1285-1289, 1967 CrossrefMedlineGoogle Scholar5. LIDDLENICHOLSONISLANDORTHABELOWDER GWDDKS: Clinical and laboratory studies of ectopic humoral syndromes. Recent Prog Horm Res 25:283-314, 1969 MedlineGoogle Scholar6. ORTH D: Results of treatment in Cushing's syndrome, in Cushing's Syndrome. Diagnosis and Treatment, edited by BINDER C, HALL P. London, W. Heinemann, 1972, p. 148 Google Scholar7. LIDDLE G: Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab 20:1539-1560, 1960 CrossrefMedlineGoogle Scholar8. COPEDENNISPEARSON CPJ: Some factors determining the adrenal response to metyrapone (SU 4885). Clin Sci 30:249-257, 1966 MedlineGoogle Scholar9. CHILDBURKEBURLEYREESFRASER DCDLT: Drug control of Cushing's syndrome. Acta Endocrinol (Kbh) 82:330-341, 1976 CrossrefMedlineGoogle Scholar10. ORTHLIDDLE DG: Results of treatment in 108 patients with Cushing's syndrome. N Engl J Med 285:243-247, 1971 CrossrefMedlineGoogle Scholar11. JENNINGSLIDDLEORTH AGD: Results of treating childhood Cushing's disease with pituitary irradiation. N Engl J Med 297:957-962, 1977 CrossrefMedlineGoogle Scholar12. ZACHMANNGITZELMANNZAGALAKPRADER MRMA: Effect of aminoglutethimide on urinary cortisol and cortisol metabolites in adolescents with Cushing's syndrome. Clin Endocrinol (Oxf) 7:63-71, 1977 CrossrefMedlineGoogle Scholar13. TEMPLEJONESLIDDLE TDG: Treatment of Cushing's disease: correction of hypercortisolism by o, p'DDD without induction of aldosterone deficiency. N Engl J Med 281:801-805, 1969 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Division of Endocrinology Vanderbilt University School of Medicine Nashville, Tennessee PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPharmacophore Modeling and in Silico/in Vitro Screening for Human Cytochrome P450 11B1 and Cytochrome P450 11B2 InhibitorsHyperadrenocorticism in CatsLCI699, a Potent 11β-hydroxylase Inhibitor, Normalizes Urinary Cortisol in Patients With Cushing's Disease: Results From a Multicenter, Proof-of-Concept StudyPhysiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal HyperplasiaMedical management of Cushing's syndromeA reappraisal of the medical therapy with steroidogenesis inhibitors in Cushing's syndromeTreatment Options in Cushing's DiseaseCushing's diseaseManagement of Cushing's Syndrome due to Ectopic Adrenocorticotropin Secretion with 1,Ortho-1, Para′-Dichloro-Diphenyl-Dichloro-Ethane: Findings in 23 Patients from a Single CenterMedical Management of Cushing's SyndromeDrugs in the medical treatment of Cushing's syndromeNon-surgical management of hormone-secreting pituitary tumorsPharmacotherapy for Hormone Excess in Adrenocortical CarcinomaPharmacological management of Cushing's syndrome: an updateMedical management of Cushing diseaseMedical management of Cushing diseaseThe Medical Management of Cushing's SyndromeCushing's DiseaseClassic and Recent Etiologies of Cushing??s SyndromeNebenniereCushing's Syndrome: Therapy Directed at the Adrenal GlandsTherapy of Cushing's syndrome with steroid biosynthesis inhibitorsSyndromes of Corticosteroid ExcessShort and long-term responses to metyrapone in the medical management of 91 patients with Cushing's syndromeReductive metabolism of metyrapone by a quercitrin-sensitive ketone reductase in mouse liver cytosolThe treatment of Cushing's syndromeCushing's SyndromeCushing's SyndromeEvidence for a delayed, integral, and proportional phase of glucocorticoid feedback on ACTH secretion in normal human volunteersAdrenal CortexDiagnosis, treatment and postoperative results of Cushing's diseaseEctopic Hormone SyndromesMetyrapone for depression and delirium secondary to Cushing's syndromeTumors of the neuroendocrine system (APUD cell tumors—Apudomas)Surgery of the AdrenalsEndokrine Aspekte des HochdrucksThe role of adrenalectomy in the management of Cushing's syndromeManagement of acute hypercortisolismPituitary Prolactinomas[44] Radioimmunoassay of metyrapone and reduced metyraponeTREATMENT OF CUSHING'S DISEASE IN CHILDRENSmall-Cell Carcinoma with Ectopic ACTH SecretionThe pharmacologic control of adrenal steroidogenesisAdrenocortical diseasesThe Adrenal Cortex 1 July 1978Volume 89, Issue 1Page: 128-130KeywordsAdrenocorticotropic hormoneBiosynthesisCortisolPatients ePublished: 1 December 2008 Issue Published: 1 July 1978 PDF downloadLoading ...