Source: Smith SM, Gums JG.
Adrenal Gland Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7992321.
Accessed May 27, 2012.
- Clinical features resulting from chronic exposure to excess
glucocorticoids of any cause.
- Pituitary adenomas (Cushing's disease)
- Ectopic ACTH-secreting tumors
- Adrenal adenomas or carcinomas
- Results from effects of supraphysiologic levels of glucocorticoids
caused by exogenous administration or endogenous overproduction
by adrenal gland (adrenocorticotropic hormone [ACTH]-dependent)
or by abnormal adrenocortical tissues (ACTH-independent).
- Ectopic ACTH syndrome is excessive ACTH production resulting
from endocrine or nonendocrine tumor, usually of pancreas, thyroid,
- ACTH-independent Cushing’s syndrome usually caused
by adrenal adenomas and carcinomas.
- Annual incidence of Cushing’s syndrome: 13 cases
per million people.
- Approximately 70% of cases due to Cushing’s
disease, 15% to ectopic ACTH-secreting tumors, and 15% to
- Chronic corticosteroid use
- Age 20–50 years
- Female sex
- Central obesity and facial rounding (90% of patients)
- Peripheral obesity and fat accumulation (50%)—fat
accumulation in dorsocervical area (buffalo hump); moon facies.
- Myopathy (65%) or muscular weakness (85%)
- Striae along lower abdomen that may have red to purple color.
- Hypertension (75–85%)
- Glucose intolerance (60%)
- Psychiatric changes (55%)
- Osteoporosis (50–60%)
- Gonadal dysfunction with amenorrhea in up to 75% of
- Excess androgen secretion with hirsutism in 80% of
- 24-hour urinary free cortisol (UFC), midnight plasma cortisol,
late-night (11 pm) salivary cortisol,
and/or low-dose dexamethasone suppression test (DST) can
- Plasma ACTH test; metyrapone stimulation test; corticotropin-releasing
hormone (CRH) stimulation test; and inferior petrosal sinus sampling
may be performed.
- High-resolution CT and MRI may identify pituitary and
- Primary and secondary aldosteronism
- Limit morbidity and mortality.
- Return patient to normal functional state by removing source
of hypercortisolism without causing pituitary or adrenal deficiencies.
- See Table 1 for treatment plans based on etiology.
Table 1. Possible Treatment
Plans in Cushing’s Syndrome Based on Etiology ||Download (.pdf)
Table 1. Possible Treatment
Plans in Cushing’s Syndrome Based on Etiology
Generic (Brand) Drug Name
Ectopic ACTH syndrome
Surgery, chemotherapy, irradiation
Metyrapone (Metopirone) 250-mg capsules
0.5–1 g/day, divided every 4–6
1–2 g/day, divided every 4–6 hr
Aminoglutethimide (Cytadren) 250-mg tablets
0.5–1 g/day, divided 2–4 times
daily for 2 wk
1 g/day, divided every 6 hr
4 mg twice daily
24–32 mg/day, divided
4 times daily
2-mg/5-mL syrup or 4-mg tablets
Mitotane (Lysodren) 500-mg tablets
0.5–1 g/day, increased by 0.5–1
g/ day every 1–4 weeks
1–4 g ...