Drugs Causing Adrenal Insufficiency

A variety of drugs used in the surgical patient may inhibit adrenal function (Table 72-3). Drugs used to inhibit steroidogenesis or exert adrenolytic activity such as aminoglutethimide, metyrapone, and o,p'-DDD (mitotane) require careful monitoring of adrenal function and frequently require steroid replacement. Rifampin and ketoconazole also cause adrenal insufficiency. Phénobarbital accelerates the catabolism of Cortisol. The anesthetic agent etomidate may suppress adrenal steroidogenesis for as long as 4 days.6

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