The nurse should question a prescription for aminoglutethimide (Cytadren) in a patient with which condition?

• A. Addison's disease
• B. Adrenal malignancy
• C. Cushing's syndrome
• D. Metastatic breast cancer

Answer: (A)

Aminoglutethimide works by blocking the enzyme that starts adrenal steroid synthesis, so it lowers production of cortisol, aldosterone, and androgens. In Addison's disease the adrenal glands are already unable to produce enough cortisol (and often aldosterone). Giving a drug that further suppresses steroid production would worsen the deficiency and can trigger an adrenal crisis. For this reason, a prescription of aminoglutethimide would be questioned in a patient with Addison's disease. The drug is used in conditions where lowering steroid production helps—such as Cushing's syndrome, adrenal malignancy, or metastatic breast cancer—where reducing cortisol or estrogen can be therapeutic.