Acromegaly – bromocriptine or octreotide
Hyperprolactinemia – surgical resection, cabergoline or bromocriptine
Cushings Disease-
- Diagnosed by a dexamethasone suppression test or 24-hour urinary cortisone test.
- Symptoms: central obesity, peripheral fat, myopathies, osteoporosis, back pain, diabetes, hirsutism, hypertension
- Treatment:
- Surgical resection if possible
- Pasireotide: 0.6-0.9 mg BID subQ (adverse effects: hypoglycemia, hypocortisolism, diarrhea, nausea, gallstones, headache, bradycardia)
- Ketoconazole: Hinders cortisol production, 200 mg BID up to 400 mg TID (adverse effects: gynecomastia, abdominal discomfort, increased LFTs)
- Mitotane: 500-1000mg daily
- Etomidate: 0.3 mg/kg IV
- Metyrapone: 500 mg TID
Primary Aldosteronism-
- Spironloactone is drug of choice. 25-50 mg/day (adverse effects: hyperkalemia, gynecomastia, abdominal discomfort)
- Eplerenone and amiloride are alternatives
Hyposecretory Adrenal Disorders or “Addison’s Disease”-
- Hydrocortisone: 15 mg/day
- Fludrocortisone (replaces mineralcorticoid): 0.05-0.2 mg/day
- Dehydrocopiandrosterone: 25-50 mg/day for libido in women
Glucocorticoid Equivalent Dosing:
| Glucocorticoid | Dose |
| Cortisone | 25 |
| Hydrocortisone | 20 |
| Prednisone | 5 |
| Prenisolone | 5 |
| Triamcinolone | 4 |
| Methylprednisone | 4 |
| Dexamathasone | 0.75 |
PCOS:
- Improve fertility with clomiphene citrate or gonadotropin
- Symptoms improve with estrogen and progestin combination
- Spironolactone can help with hirsutism