Метирапон

Metyrapone acts as a glucocorticoid synthesis inhibitor, maintaining stress-hormone levels.

Cytochrome P450 inhibitor. Blocks glucocorticoid synthesis via inhibition of steroid 11- β hydroxylase (CYP11B1) activity (IC 50 = 7.83 μ M). Also inhibits CYP3A4 and cytochrome P450-mediated ω / ω -1 hydroxylase activity.

Metyrapone (Metopirone) produces its primary pharmacological effect by inhibiting 11-β-hydroxylase, thereby causing diminished production and release of cortisol. The resulting reduction in the negative feedback of cortisol on the hypothalamus and pituitary causes an increase in corticotrophin release and in the secretion of precursor 11-deoxysteroids.

Metyrapone is used in the differential diagnosis of both adrenocortical insufficiency and Cushing’s syndrome (hypercortisolism). The drug tests the functional competence of the hypothalamic–pituitary axis when the adrenals are able to respond to corticotrophin; that is, when primary adrenal insufficiency has been ruled out.
After metyrapone administration, a patient with a disease of pituitary origin cannot achieve a compensatory increase in the urinary excretion of 17-hydroxycorticosteroids or 11-deoxysteroids. Moreover, if pituitary corticotrophin is suppressed by an autonomously secreting adrenal carcinoma, there will be no increase in response to metyrapone. On the other hand, if pituitary corticotrophin secretion is maintained, as occurs in adrenal hyperplasia, the inhibition of corticoid synthesis produced by metyrapone will stimulate corticotrophin secretion and the release of metabolites of precursor urinary steroids, which can be measured as 17-hydroxycorticosteroids. Metyrapone is now used less frequently in the differential diagnosis of Cushing’s syndrome because of the ability to measure plasma corticotrophin directly.
The steroid-inhibiting properties of metyrapone have also been used in the treatment of Cushing’s syndrome, and it remains one of the more effective drugs used to treat this syndrome. However, the compensatory rise in corticotrophin levels in response to falling cortisol levels tends to maintain adrenal activity.This requires that glucocorticoids be administered concomitantly to suppress hypothalamic–pituitary activity. Although metyrapone interferes with 11β- and 18- hydroxylation reactions and thereby inhibits aldosterone synthesis, it may not cause mineralocorticoid deficiency because of the compensatory increased production of 11-desoxycorticosterone.

Side effects associated with the use of metyrapone include gastrointestinal distress, dizziness, headache, sedation, and allergic rash. The drug should not be used in cases of adrenocortical insufficiency or when hypersensitivity reactions can be expected. When administered to pregnant women during the second or third trimesters, the drug may impair steroid biosynthesis in the fetus. Because metyrapone is relatively nontoxic, it is used in combination therapy with the more toxic aminoglutethimide to reduce its dosage.