[Adrenostatic treatment of ACTH-dependent Cushing syndrome using metyrapone and aminoglutethimide]

The adrenostatic effect of metyrapone (Metopiron) and aminoglutethimide (Orimeten) was assessed retrospectively in ten patients with ACTH-dependent Cushing's syndrome, four of them with the ectopic form. Five patients received metyrapone only, the other five both metyrapone and aminoglutethimide. Persistent lowering of the serum cortisol level was achieved in all, after an observation period of two weeks to four years. The intended therapeutic level of below 16 micrograms/100 ml was achieved in seven patients. In the course of treatment there was a rise in mean plasma ACTH concentration, but without an "escape" phenomenon. The adrenostatic treatment had to be limited, if at all, only because of side effects, which in two patients required that the drug administration be terminated. It is concluded that adrenostatic treatment with metyrapone and aminoglutethimide is effective and practical. It is suitable not only in the management of florid Cushing's syndrome, but also for long-term treatment when complete cure is not possible.