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Table 1 Drug related glucocorticoid insufficiency

From: Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids

Mechanisms

Drugs

Primary adrenal insufficiency

 

   Haemorrhage

Anticoagulant therapy (heparin, warfarin)

   Cortisol synthesis enzyme inhibition

Aminogluthethimide

 

Ketoconazole

 

Fluconazole

 

Etomidate

 

Dexmedetomidine

   Cortisol metabolism activation

Phenobarbital

 

Phenytoin

 

Rifampin

Secondary adrenal insufficiency

 

   Suppression of CRH and ACTH synthesis

Glucocorticoid therapy (systemic or topical)

 

Megestrol acetate

 

Medroxyprogesterone

 

Ketorolac tromethamine

 

Antidepressant drugs (e.g. imipramine)

 

Opiate drugs

Peripheral resistance to glucocorticoids

 

   Interaction with glucocorticoids receptor

Mifepristone

   Inhibition of the glucocorticosteroid-induced gene transcription

Antipsychotic drugs (e.g. chlorpromazine)

 

Antidepressant drugs (e.g. imipramine)

  1. ACTH, adrenocorticotrophic hormone; CRH, corticotropin-releasing hormone.