Which medication is used for treatment of Cushing disease?

Which medication is used for treatment of Cushing disease?

• A. Ketoconazole
• B. Metyrapone
• C. Hydrocortisone
• D. Spironolactone

Answer: (B)

The main idea here is lowering cortisol production by blocking adrenal steroid synthesis. Metyrapone works by inhibiting the enzyme 11β-hydroxylase in the adrenal cortex, which is the final step converting 11-deoxycortisol to cortisol. By blocking this step, cortisol levels fall, helping to control the hypercortisolism seen in Cushing disease. Clinically, metyrapone is used as bridging therapy or when surgery isn’t immediately possible, to safely reduce cortisol and stabilize the patient. It can, though, cause buildup of precursors that may increase androgens, leading to hypertension or hirsutism, so monitoring is important. Hydrocortisone would worsen the condition since it adds cortisol; spironolactone doesn’t reduce cortisol synthesis; ketoconazole also lowers cortisol but via different enzymatic targets and carries potential liver toxicity, whereas metyrapone directly blocks the final cortisol-producing step.

The main idea here is lowering cortisol production by blocking adrenal steroid synthesis. Metyrapone works by inhibiting the enzyme 11β-hydroxylase in the adrenal cortex, which is the final step converting 11-deoxycortisol to cortisol. By blocking this step, cortisol levels fall, helping to control the hypercortisolism seen in Cushing disease. Clinically, metyrapone is used as bridging therapy or when surgery isn’t immediately possible, to safely reduce cortisol and stabilize the patient. It can, though, cause buildup of precursors that may increase androgens, leading to hypertension or hirsutism, so monitoring is important. Hydrocortisone would worsen the condition since it adds cortisol; spironolactone doesn’t reduce cortisol synthesis; ketoconazole also lowers cortisol but via different enzymatic targets and carries potential liver toxicity, whereas metyrapone directly blocks the final cortisol-producing step.