Which of the following is used for medical adrenalectomy: September 2009

Ans. D: All of the above Medical care for Cushing syndrome can be summarized as follows: Agents that inhibit steroidogenesis, such as mitotane, ketoconazole, metyrapone, aminoglutethimide, trilostane, and etomidate, have been used to cause medical adrenalectomy. These medications are used rarely and often are toxic at the doses required to reduce coisol secretion. Efficacy of these medical interventions can be assessed with serial measurements of 24-hour urinary free coisol. - Patients receiving these medications may require glucocoicoid replacement to avoid adrenal insufficiency. - Metyrapone and trilostane are agents that competitively inhibit a single steroidogenic enzyme. Ketoconazole and aminoglutethimide act at several sites. Because ACTH production may persist or increase in patients with Cushing disease, radiation therapy of the pituitary is often required after unsuccessful initial therapy, either surgical or medical. These agents have higher efficacy when used in combination because they may act synergistically. Ketoconazole is probably the most popular and effective of these agents for long-term use and usually is the agent of choice