Question: What medications are available to lower steroid production, what are the side effects, and when are these drugs used?

Answer: There are several medications available to lower steroid production and these can be used to treat patients temporarily until more definitive surgical intervention is possible. Ketoconazole is the most widely used medication. It is usually well tolerated, but is often accompanied by some mild liver function abnormalities which may necessitate its discontinuation. Metyrapone, often used in combination with Ketoconazole, is another agent and it is usually well tolerated. Aminoglutethimide is a potent drug which blocks the production of all steroids from the adrenal gland. It is associated with somnolence and GI side effects. Mitotane is a drug that damages the adrenal gland decreasing steroid secretion. This drug is often used in patients with adrenal cancer. It is associated with a great deal of nausea and vomiting and therapeutic doses are poorly tolerated in many patients. RU-486 (the controversial abortion pill) can also be used to block the effects of cortisol and decrease the symptoms of Cushing's syndrome. Due to the political volatility of this drug, it may never be available for use in the United States. Although all of these medications may be helpful in selected patients, they should only be used by endocrinologists with experience in managing patients with Cushing's syndrome.