Adrenal Disorders

- Inhibition of cortisol synthesis and release, alters peripheral metabolism of cortisol
- this is cytotoxic drug
PK/Mon- slow inset, moniter free urin corticol to guide therapy

Use: adrenal adenoma, or other cases when medical adrenalectomy is needed. must be given w/ exogenous steroids
AE: drowsiness, anorexia, GI muscle weakness

MOA: inhibits cholesterol desmolase to decreases prenolone and all the adrenal cortex hormones downstream, inclusing estrogen
AE: drowsiness, bone marrow suppression, drug induced lupus
- Metyrapone

MOA: inhibits 11 BETA hydroxylase to decreases cortisol and sometimes also aldosterone
AE: hypokalemia, rash, hirsuitism

MOA: antifungal that inhibits 11 beta, 17 alpha, and cholesterol desmolase, and testosterone at higher doses
AE: drug interactions, GI, increases LFTs, impotence, gynecomastia

MOA: glucocorticoid and progesterone antagonist
Use: chiefly as an abortifactent, Cushings, progesterone positive cancers

MOA: minercorticoid agonist
Use: adrenal insufficiency, dose based on serum K+ (when high K+means dose must be increased) and on BP (if low BP means hsould increase the dose)

Class: short acting corticosteroids-- 8 hrs
MOA: primarily cortisol agonist but also some mineralcorticoid agonism, low antiinflammatory potency but acts like mineralocorticoid

CLass: intermediate acting - 12 hrs
MOA: primarily cortisol agonist (also some mineralocorticoid agonism), pretty anti inflammatory

Class: long acting cortisol agonist
MOA:very potent anti-inflammatory, never acts like a mineralocorticoid

Use: replacement therapy, asthma/allergies, rheumatic disease, IBD (Crohn’s & UC), COPD, organ transplantation, etc, etc, etc
AE withdrawal: 1) Disease flare-up if indicated for auto-immune disease OR (2) Acute adrenal insufficiency: N/V, hypoglycemia, dizziness, dyspnea, arthralgia

- HTN, low K+, hyperglycemia, hyperlipidemia, infection, peptic ulcer disease, cataracts, myopathy, teratogenicity and all other effects seen in Cushings
o Consider alternative day therapy to minimize above

2 wks

- alternating day therapy