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

Abstract

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.

Medical Treatment of Cushing's Disease

“…The dose given parenterally is between 0.03 and 0.3 mg/kg/h (3). Recently, the use of etomidate in the treatment of CS was reviewed, and protocols for a safe and effective use of etomidate in CS are warranted (88).…”

Etomidate in the emergency management of hypercortisolemia

“…We read with interest the recent paper by Preda et al (1) in which i.v. etomidate infusion for the management of Cushing's syndrome was reviewed.…”

Practical aspects of etomidate use in the management of hypercortisolaemia

“…We appreciate the letter from of Dr Soh et al regarding our review on the use of etomidate in the treatment of Cushing's syndrome (1). We note that in their experience, our recommended dose regimen of 2.5 mg/h or thereabouts appears to be a safe and effective starting dose in most patients, and we note the utility and ease of use of the lipid formulation and its relative freedom from side effects compared with the more commonly used propylene glycol formulation; these are very helpful comments.…”