Which medication would be prescribed for ACTH-mediated Cushingoid features (e.g., moonface) as described in the scenario?

Which medication would be prescribed for ACTH-mediated Cushingoid features (e.g., moonface) as described in the scenario?

• A. cyproheptadine
• B. hydrocortisone
• C. spironolactone
• D. prednisone

Answer: (A)

When ACTH drives cortisol excess, the goal is to lower cortisol production or block its effects, not to add steroids or treat unrelated pathways. Hydrocortisone and prednisone would worsen the problem by increasing glucocorticoid activity. Spironolactone can help with fluid balance and electrolyte issues that accompany Cushingoid states, but it does not reduce cortisol levels or block its action. Cyproheptadine has no established role in addressing cortisol excess or Cushingoid features. The medications that would directly address ACTH-mediated Cushingoid features are those that reduce cortisol production (such as cortisol-synthesis inhibitors) or block cortisol’s action (glucocorticoid receptor antagonists). Examples include agents like ketoconazole or metyrapone to decrease synthesis, or mifepristone to block receptor effects.

When ACTH drives cortisol excess, the goal is to lower cortisol production or block its effects, not to add steroids or treat unrelated pathways. Hydrocortisone and prednisone would worsen the problem by increasing glucocorticoid activity. Spironolactone can help with fluid balance and electrolyte issues that accompany Cushingoid states, but it does not reduce cortisol levels or block its action. Cyproheptadine has no established role in addressing cortisol excess or Cushingoid features.

The medications that would directly address ACTH-mediated Cushingoid features are those that reduce cortisol production (such as cortisol-synthesis inhibitors) or block cortisol’s action (glucocorticoid receptor antagonists). Examples include agents like ketoconazole or metyrapone to decrease synthesis, or mifepristone to block receptor effects.