Adrenal insufficiency drug-induced

Drug-induced (most common cause of secondary adrenal insufficiency)... 

Fhtients may require a lower dose of glucocorticoid than those with primary adrenal insufficiency. Some patients will only require glucocorticoid replacement temporarily, which can be discontinued after recovery of the HPA axis (e.g., drug-induced adrenal insufficiency, adrenal insufficiency following treatment for Cushing s syndrome). 

Causes of adrenal insufficiency, including drug-induced etiologies. 

Some antifungal drugs such as ketoconazole (see Chapter 48) inhibit CYPs and thereby block the synthesis of steroid hormones, including testosterone and cortisol. Because they may induce adrenal insufficiency and are associated with hepatotoxicity, these drugs generally are not used to inhibit androgen synthesis, but sometimes are employed in cases of glucocorticoid excess. 

Epinephrine itself is not mydriatic when it is applied locally to the normal human eye, possibly because it is not sufficiently well absorbed from the conjunctival sac nor does epinephrine produce mydriasis when it is injected into man, unless the sympathetic fibers to the iris have degenerated (e.g., as the result of extirpation of the superior cervical ganglion) or the iris is sensitized by thyroxine, as in hyperthyroid patients. In experimental animals, however, drugs which induce a liberal outflow of epinephrine from the adrenal medulla do produce mydriasis. Epinephrine has therefore the capacity of dilating the pupil, but only when it can reach the site of action in sufficient concentration it must be concluded that local application of the drug does not enable this concentration to be achieved, and that the amounts of it which can be safely injected are also insufficient to effect mydriasis in patients with normal eyes. 

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