Several compounds inhibit adrenal steroidogenesis by interfering with one or more of the enzymes in the steroidogenic pathway (figure 1 and figure 2). (See "Adrenal steroid biosynthesis".)
These compounds have been used to study the enzymes involved in steroid synthesis, to evaluate the hypothalamic-pituitary axis (metyrapone), and to treat some patients with endogenous excess of cortisol, androgen, or mineralocorticoid secretion.
Indications for the use of these compounds include rapid control of severe hypercortisolism for any etiology of endogenous Cushing's syndrome, persistent hypercortisolism following pituitary surgery for Cushing's disease, while awaiting the control from radiotherapy for Cushing’s disease, and control of excess steroid production in adrenocortical carcinoma or ectopic adrenocorticotropic hormone (ACTH) syndrome.
This topic provides an overview of the compounds that inhibit glucocorticoid biosynthesis or action. Their use in the treatment of Cushing's syndrome is reviewed in greater detail separately. (See "Medical therapy of hypercortisolism (Cushing's syndrome)".)