Nonhypnotic low-dose etomidate for rapid correction of hypercortisolaemia in cushing's syndrome

Allolio, Bruno; Schulte, Heinrich M.; Kaulen, D.; Reincke, Martín; Jaursch-Hancke, Cornelia; Winkelmann, W.

doi:10.1007/bf01735795

Cited by 59 publications

(28 citation statements)

References 20 publications

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“…In the original study by Allolio et al (20) using etomidate for cortisol suppression, tiredness was reported in some patients at doses of 0.3 mg/kg per h. Doses of 0.04-0.05 mg/kg per h were found to adequately inhibit, but not sedate, and this was further clarified in dose-response studies by Schulte et al (12) demonstrating inhibition of adrenal steroidogenesis at 0.01-0.1 mg/kg per h (20). Several publications that followed report sub-hypnotic i.v.…”

Section: Clinical Experiencementioning

confidence: 99%

“…This requires measurement of the cortisol levels and also the cortisol response to exogenous ACTH to demonstrate complete or partial blockade. In order to demonstrate 'escape', an increase in endogenous ACTH and cortisol secretion must occur with exogenous ACTH (20,26). There is no true resistance to etomidate with this escape phenomenon.…”

Section: Clinical Experiencementioning

confidence: 99%

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THERAPY IN ENDOCRINE DISEASE: Etomidate in the management of hypercortisolaemia in Cushing's syndrome: a review

Preda

Sen

Karavitaki

et al. 2012

European Journal of Endocrinology

138

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This review addresses the practical usage of intravenous etomidate as a medical therapy in Cushing's syndrome. We reviewed the relevant literature, using search terms 'etomidate', 'Cushing's syndrome', 'adrenocortical hyperfunction', 'drug therapy' and 'hypercortisolaemia' in a series of public databases. There is a paucity of large randomised controlled trials, and data on its use rely only on small series, case study reports and international consensus guideline recommendations. Based on these, etomidate is an effective parenteral medication for the management of endogenous hypercortisolaemia, particularly in cases with significant biochemical disturbance, sepsis and other serious complications such as severe psychosis, as well as in preoperative instability. We suggest treatment protocols for the safe and effective use of etomidate in Cushing's syndrome.

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Section: Clinical Experiencementioning

confidence: 99%

Section: Clinical Experiencementioning

confidence: 99%

THERAPY IN ENDOCRINE DISEASE: Etomidate in the management of hypercortisolaemia in Cushing's syndrome: a review

Preda

Sen

Karavitaki

et al. 2012

European Journal of Endocrinology

138

View full text Add to dashboard Cite

show abstract

“…Studies have demonstrated that etomidate directly inhibits adrenal steroidogenesis [32,33] and the primary mode of action is thought to be inhibition of 11β-hydroxylation of gluco- and mineralocorticoids [6,34,35]. These studies, in patients and adrenal cell lines, consistently show a rise in 11-deoxycortisol and 11-deoxycorticosterone associated with a decrease in cortisol and corticosterone concentrations after low-dose etomidate administration [6,16,34,35,36,37,38,39,40]. However, higher concentrations of etomidate result in a reduction in 17α-OH-progesterone and progesterone concentrations, suggesting inhibition of other cytochrome P450-dependent enzymes, e.g.…”

Section: Discussionmentioning

confidence: 94%

Use of Intravenous Etomidate to Control Acute Psychosis Induced by the Hypercortisolaemia in Severe Paediatric Cushing’s Disease

Chan¹,

Vaidya

Westphal³

et al. 2011

Horm Res Paediatr

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Background: Psychosis secondary to paediatric Cushing’s disease (CD) is extremely rare and presents a significant management challenge. Method: We report a 14.7-year-old CD patient with acute psychosis and self-inflicted injuries following failed transsphenoidal pituitary surgery. Her mental state rapidly deteriorated precluding medical therapy. Results: Emergency intravenous low-dose etomidate infusion (3–3.5 mg/h) with dose titration according to the serum cortisol combined with a hydrocortisone infusion, in an intensive care setting, was effective in controlling the hypercortisolaemia. Her mental state improved with normalisation of her cortisol levels enabling oral administration of ketoconazole and bilateral adrenalectomy to be performed. Conclusion: This case illustrates the safe and effective use of a low-dose etomidate infusion in an unusual case of paediatric CD.

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“…In clinical studies, this has been demonstrated by Schulte et al (4), where varying doses of etomidate infusion at 0.03, 0.1 and 0.3 mg/kg per h showed prominent sedation only at the highest dose. Allolio et al (5) corroborated this in subjects with Cushing's syndrome, where low-dose etomidate infusion at 2.5 mg/h decreased mean cortisols to 53% in 7 h without any sedative complications.…”

mentioning

confidence: 80%

Etomidate in the emergency management of hypercortisolemia

Soh

Gunganah

Akker

et al. 2012

European Journal of Endocrinology

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Nonhypnotic low-dose etomidate for rapid correction of hypercortisolaemia in cushing's syndrome

Cited by 59 publications

References 20 publications

THERAPY IN ENDOCRINE DISEASE: Etomidate in the management of hypercortisolaemia in Cushing's syndrome: a review

THERAPY IN ENDOCRINE DISEASE: Etomidate in the management of hypercortisolaemia in Cushing's syndrome: a review

Use of Intravenous Etomidate to Control Acute Psychosis Induced by the Hypercortisolaemia in Severe Paediatric Cushing’s Disease

Etomidate in the emergency management of hypercortisolemia

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