Medical adrenalectomy is seen with-
**Core Concept**
Medical adrenalectomy refers to the pharmacological suppression of adrenal steroid hormone production, particularly cortisol and aldosterone. This can be achieved through the use of medications that inhibit the enzyme 11-beta hydroxylase, which is crucial for the production of cortisol.
**Why the Correct Answer is Right**
The correct answer involves the use of **metyrapone**, a medication that selectively inhibits the enzyme 11-beta hydroxylase, thereby preventing the conversion of 11-deoxycortisol to cortisol. This leads to a decrease in cortisol production, effectively causing a "medical adrenalectomy." Metyrapone is often used in the diagnosis and treatment of Cushing's syndrome, a condition characterized by excessive cortisol levels.
**Why Each Wrong Option is Incorrect**
* **Option A:** Mifepristone is a glucocorticoid receptor antagonist, which blocks the action of cortisol rather than reducing its production. It is used in the treatment of Cushing's syndrome but does not achieve a medical adrenalectomy.
* **Option B:** Ketoconazole is an antifungal medication that also inhibits the production of adrenal steroids, including cortisol and aldosterone. However, it does so by inhibiting the enzyme P450c17, which is involved in the production of both cortisol and sex hormones. This is not a selective inhibition of 11-beta hydroxylase.
* **Option C:** Spironolactone is a potassium-sparing diuretic that acts as an aldosterone antagonist, preventing the action of aldosterone rather than reducing its production. It is used in the treatment of hypertension and heart failure but does not achieve a medical adrenalectomy.
**Clinical Pearl / High-Yield Fact**
Metyrapone is a useful medication for diagnosing and treating Cushing's syndrome due to its ability to selectively inhibit cortisol production. It can be used in conjunction with dexamethasone suppression tests to differentiate between ACTH-dependent and ACTH-independent causes of Cushing's syndrome.
**Correct Answer: C. Metyrapone**