Metyrapone as a Bridging Therapy in Florid Cushing’s Disease Patients Prior to Pituitary Adenomectomy

This case study highlights the use of metyrapone as an effective preoperative treatment in a 31-year-old female with florid Cushing's disease, characterized by severe metabolic abnormalities and symptoms such as alopecia and hirsutism. Metyrapone, administered at doses titrated from 250 mg to 500 mg TDS, successfully normalized cortisol levels and improved blood pressure and glucose control, allowing for safer pituitary adenomectomy. The study underscores metyrapone's role in managing severe Cushing's disease when surgery is delayed or rapid cortisol reduction is necessary.