Which medication is used to treat Cushing disease?

Which medication is used to treat Cushing disease?

• A. Metyrapone
• B. Hydrocortisone
• C. Dexamethasone
• D. Fludrocortisone

Answer: (A)

In Cushing disease, the medical goal is to lower cortisol production from the adrenal glands. Metyrapone achieves this by blocking the enzyme 11β-hydroxylase, a key step in the final synthesis of cortisol. By inhibiting this enzyme, cortisol levels fall, helping to reduce the signs and biochemical effects of hypercortisolism while other definitive treatments (like pituitary surgery) are pursued or considered. Hydrocortisone would add more cortisol, not reduce it, so it’s not a treatment for the excess. Dexamethasone is a synthetic glucocorticoid used mainly for anti-inflammatory effects or in diagnostic suppression tests, not to treat already elevated cortisol. Fludrocortisone is a mineralocorticoid replacement used for low aldosterone activity, not for reducing cortisol production. Therefore, metyrapone best fits the goal of decreasing cortisol synthesis in Cushing disease.

In Cushing disease, the medical goal is to lower cortisol production from the adrenal glands. Metyrapone achieves this by blocking the enzyme 11β-hydroxylase, a key step in the final synthesis of cortisol. By inhibiting this enzyme, cortisol levels fall, helping to reduce the signs and biochemical effects of hypercortisolism while other definitive treatments (like pituitary surgery) are pursued or considered.

Hydrocortisone would add more cortisol, not reduce it, so it’s not a treatment for the excess. Dexamethasone is a synthetic glucocorticoid used mainly for anti-inflammatory effects or in diagnostic suppression tests, not to treat already elevated cortisol. Fludrocortisone is a mineralocorticoid replacement used for low aldosterone activity, not for reducing cortisol production. Therefore, metyrapone best fits the goal of decreasing cortisol synthesis in Cushing disease.