Table 12.

Therapeutic Agents for Hormonal Control

Hormonal Derangement	Medication	Dose per Day	Side Effects
Hypercortisolism	Mitotane	2–12 g, to target level 14–20 mg/L	See Table 7, use mainly for adrenolytic effects
	Mifepristone	300–1200 mg	Fatigue, nausea, headache, hypokalemia, arthralgia, vomiting, edema, and endometrial thickening
	Metyrapone	250–3000 mg	Hyperandrogenemia
	Ketoconazole	200–1200 mg	Nausea, vomiting, abdominal pain, hepatotoxicity
	Etomidate	0.02–0.03 mg/kg/h	Sedation (usually occurs at significantly higher doses)
	Aminoglutethemidea	250–1000 mg	Rash, nausea, vomiting, anorexia, sedation, lethargy
Mineralocorticoid excess	Spironolactone	25–200 mg	Hyperkalemia, gynecomastia
	Eplerenone	50–200 mg	Hyperkalemia
Hyperandrogenemia	Spironolactone		Hyperkalemia, gynecomastia
Estrogen excess	Aromatase inhibitors	Anastrazole 1 mg	Bone loss, nausea
		Letrozole 2.5 mg
		Exemestane 25 mg
	SERMs (tamoxifen, raloxifene)	Tamoxifen 20–40 mg, raloxifen 60 mg	Deep venous thrombosis

Abbreviation: SERM, selective estrogen receptor modulator.

^aNot commonly available anymore.