endocrine and metabolic disorders
Adrenal Virilism
Treatment of Adrenal Virilism
Oral glucocorticoids for hyperplasia Removal of tumors Glucocorticoids are used for adrenal hyperplasia, typically oralhydrocortisone10 mg on arising, 5 mg at midday, and 5 mg in the late afternoon. Alternatively,dexamethasone0.5 to 1 mg orally may be given at bedtime, but even these small doses may cause signs of Cushing syndrome; therefore, this form of glucocorticoid is generally not recommended. Giving the dose at bedtime is most appropriate in terms of suppressing ACTH secretion but may cause insomnia.Cortisoneacetate 25 mg orally once a day orprednisone5 or occasionally up to 10 mg orally once a day can be used instead. Slower-release forms ofhydrocortisoneare also available and may provide better biochemical control. Although most symptoms and signs of virilism disappear with treatment, hirsutism and baldness disappear slowly, the voice may remain deep, and fertility may be impaired. Tumors require adrenalectomy. For patients withcortisol-secreting tumors,hydrocortisoneshould be given preoperatively and postoperatively because their nontumorous adrenal cortex will be atrophic and suppressed. 