Glucocorticoid Overproduction

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Introduction

exogenous glucocorticoids is the commonest cause.

Cushing's Disease: pituitary ACTH overproduction, resulting in bilateral adrenal hyperplasia.

Ectopic ACTH: SCLC, pancreatic tumors, thyroid tumors, phaeochromocytomas

Adrenal tumours: GC-producing tumours

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

treat severe hypokalemia with spironolactone, blocking 11β-hydroxylation and dehydrogenation
Nizoral used to inhibit CP450s
aminoglutethimide: reversible inhibits a CP450, blocking conversion of cholesterol to pregnenolone
combination therapy useful
mitotane induces necrosis of adrenal cortex; used in treatment of adrenocortical carcinoma

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