Etomidate infusion at low doses is an effective and safe treatment for severe Cushing’s syndrome outside intensive care

Consensus on diagnosis and management of Cushing's disease: a guideline update

“…198 Low-dose etomidate (0.04-0.05 mg/kg/h) produces partial blockade; a high-dose (0.5-1 mg/kg/h) provides for complete blockade, with IV hydrocortisone used to avoid etomidateinduced AI. 199 Very low doses (0.025 mg/kg/h) may be used in hospitalized patients outside ICU, 200 although this may depend on local practice.…”

Medical management of Cushing's disease: When and how?

“…As an example, the association of ketoconazole and metyrapone given at high doses led to normal urinary free cortisol (UFC) in 15–30 days in 63%–73% cases (with 14%–36% of patients presenting with adrenal insufficiency thereafter), associated with a major decrease in cortisol levels beginning on day 3 of medical treatment 8,9 . Etomidate, a drug used for the induction of anaesthaesia, also induced a rapid powerful blockade of steroidogenesis, as shown by 83% normal UFC in 12 cases recently reported 10 . Finally, Tabarin et al 11 reported a normal UFC level in three patients presenting with adrenal carcinoma and severe hypercortisolism, when on osilodrostat (3–44 mg day −1 ).…”

“…8,9 Etomidate, a drug used for the induction of anaesthaesia, also induced a rapid powerful blockade of steroidogenesis, as shown by 83% normal UFC in 12 cases recently reported. 10 Finally, Tabarin et al 11 reported a normal UFC level in three patients presenting with adrenal carcinoma and severe hypercortisolism, when on osilodrostat (3-44 mg day À1 ). The fact that most of the patients reported in these series were not presenting with CD emphasises the rarity of severe hypercortisolism in these patients.…”