Transient acute adrenal insufficiency is seen with which of the following drug.
**Core Concept**
Transient acute adrenal insufficiency, also known as adrenal crisis, is a life-threatening condition caused by a sudden and severe deficiency of cortisol and/or aldosterone. This can be precipitated by various factors, including medications that interfere with adrenal function.
**Why the Correct Answer is Right**
The correct answer is **Ketamine**, which is a medication that can cause transient acute adrenal insufficiency. This is due to its ability to inhibit the release of corticotropin-releasing hormone (CRH) from the hypothalamus, leading to a decrease in adrenocorticotropic hormone (ACTH) secretion. As a result, the adrenal glands produce less cortisol, leading to adrenal insufficiency.
**Why Each Wrong Option is Incorrect**
* **Option A:** **Aminoglutethimide** is an inhibitor of steroidogenesis, but it is not commonly associated with transient acute adrenal insufficiency.
* **Option B:** **Metyrapone** is a medication that inhibits the enzyme 11β-hydroxylase, which is involved in cortisol synthesis, but it is more commonly used to diagnose adrenal insufficiency rather than cause it.
* **Option C:** **Ethacrynic acid** is a loop diuretic that can cause hypokalemia and metabolic alkalosis, but it is not typically associated with adrenal insufficiency.
**Clinical Pearl / High-Yield Fact**
It's essential to recognize that patients on long-term corticosteroid therapy are at risk of adrenal insufficiency, especially during times of stress or illness. A rapid taper of corticosteroids can lead to adrenal crisis, highlighting the need for careful management.
**Correct Answer:** C. Ketamine.