• Adrenal Pharmacology

The adrenal axis includes:

• Glucocorticoids (cortisol)
• Mineralocorticoids (aldosterone)
• Adrenal androgens
• Steroid synthesis pathways
• ACTH regulation

Short-Acting:

• Hydrocortisone (Cortef®)
• Cortisone

Intermediate-Acting:

• Prednisone (Deltasone®)
• Prednisolone
• Methylprednisolone (Medrol®)
• Triamcinolone

Long-Acting:

• Dexamethasone (Decadron®)
• Betamethasone

Used in:

• Adrenal insufficiency
• Inflammatory disorders
• Autoimmune disease
• Cerebral edema
• Oncology

• Fludrocortisone (Florinef®)

Used in:

• Primary adrenal insufficiency
• Salt-wasting congenital adrenal hyperplasia

• Ketoconazole
• Metyrapone
• Osilodrostat (Isturisa®)
• Etomidate (IV for severe Cushing’s)
• Abiraterone (Zytiga®)

Used in:

• Cushing syndrome
• Hypercortisolism
• Prostate cancer (abiraterone)

• Mifepristone (Korlym®)

Used in:

• Cushing syndrome with hyperglycemia

(Linked in Cardiovascular but physiologically adrenal)

• Spironolactone (Aldactone®)
• Eplerenone (Inspra®)

Used in:

• Primary hyperaldosteronism
• Resistant hypertension
• Heart failure

• Cosyntropin (Cortrosyn®)

Used in:

• ACTH stimulation testing

• Mitotane (Lysodren®)

Used in:

• Adrenocortical carcinoma

Alpha Blockade:

• Phenoxybenzamine
• Phentolamine

Beta Blockade (after alpha):

• Propranolol

Adrenal Insufficiency:

• Hydrocortisone
• Fludrocortisone

Cushing Syndrome:

• Ketoconazole
• Metyrapone
• Osilodrostat
• Mifepristone
• Mitotane

Primary Hyperaldosteronism:

• Spironolactone
• Eplerenone

Adrenocortical Carcinoma:

• Mitotane

Glucocorticoids

Short-Acting:

• Hydrocortisone (Cortef®)
• Cortisone

Intermediate-Acting:

• Prednisone (Deltasone®)
• Prednisolone
• Methylprednisolone (Medrol®)
• Triamcinolone

Long-Acting:

• Dexamethasone (Decadron®)
• Betamethasone

Mineralocorticoids

• Fludrocortisone (Florinef®)

Steroid Synthesis Inhibitors

• Ketoconazole
• Metyrapone
• Osilodrostat (Isturisa®)
• Etomidate (IV for severe Cushing’s)
• Abiraterone (Zytiga®)

• Mifepristone (Korlym®)

(Linked in Cardiovascular but physiologically adrenal)

• Spironolactone (Aldactone®)
• Eplerenone (Inspra®)

• Cosyntropin (Cortrosyn®)

• Mitotane (Lysodren®)