Aminoglutethimide, often used at a dose of 250 mg two to three times daily, prevents conversion of cholesterol to pregnenolone. In an original study of 33 patients with Cushing disease receiving a 250-mg dosage of amino-glutethimide three times daily; Gross, Mindea, Chandler and Batjer noted a clinical and biochemical remission rate of 42%, the latter defined as a 50% reduction in morning serum cortisol levels or a return to normal limits. According to the authors (Gross, Mindea, Chandler and Batjer), it is generally accepted that aminoglutethimide is, overall, not efficacious as monotherapy because its effect is generally not strong enough to normalize urinary cortisol levels, likely owing to, in part, the ability of resultant elevated ACTH