Metyrapone confers BP-lowering benefit in mild autonomous cortisol secretion

Taking metyrapone in the evening results in significant reductions in systolic (SBP) and diastolic blood pressure (DBP) without causing adrenal insufficiency in patients with mild autonomous cortisol secretion (MACS), according to a retrospective study.

The study included 15 patients with MACS (median age 67 years, 11 female) who received metyrapone 250–500 mg at 6 PM and 250 mg at 10 PM. These patients were matched to 15 participants with adrenal incidentalomas and non-suppressed serum cortisol following 1-mg overnight dexamethasone suppression testing, based on age and sex.

Outcomes of interest included tolerability at 6 months (defined as continuing to take metyrapone at 6 months) and change in SBP and DBP, weight, HbA1c, and non-HDL cholesterol between baseline and 6 months. 

No adrenal crises occurred over 6 months. Metyrapone was stopped in two patients with MACS due to side effects, such as diarrhoea in one patient and persistently elevated serum testosterone and DHEAS levels in a female patient. All other side effects, including dizziness, headaches, and nausea, were transient and tolerated. 

Compared with controls, MACS patients treated with evening metyrapone had marked reductions in SBP (−17.7 vs 8.7 mm Hg; p=0.008) and DBP (−9.9 vs 3 mm Hg; p=0.024). The between-group differences in HbA1c, weight, and non-HDL cholesterol were not statistically significant.