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J Endocr Soc. 2018 Oct 26;3(1):1-12. doi: 10.1210/js.2018-00269. eCollection 2019 Jan 1.

Continuous Etomidate Infusion for the Management of Severe Cushing Syndrome: Validation of a Standard Protocol.

Author information

1
Endocrine Center and Clinics, Froedtert Hospital and the Medical College of Wisconsin, Menomonee Falls, Wisconsin.
2
Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin.
3
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Department of Pharmacy, NorthShore University Health System, Evanston, Illinois.
5
Division of Endocrinology, University of Chicago, NorthShore University Health System, Skokie, Illinois.

Abstract

Objective:

Demonstrate the safety and efficacy of a standardized intravenous etomidate infusion protocol in normalizing cortisol levels in patients with severe and life-threatening hypercortisolism.

Methods:

A retrospective case series of seven patients representing nine episodes of severe hypercortisolism at two large academic medical centers was conducted. Patients were included in this series if they received an etomidate infusion for the treatment of severe and life-threatening hypercortisolism. The etomidate infusion was administered via a newly developed protocol designed to safely reduce cortisol levels until more long-term medical or definitive surgical therapy could be instituted.

Results:

Seven patients representing nine episodes received etomidate treatment. In eight of nine episodes of therapy, rapid control of hypercortisolemia was achieved, generally defined as a serum cortisol level of 10 to 20 µg/dL. Patients with a median baseline cortisol of 105 µg/dL (range, 32 to 245 µg/dL) achieved a median nadir serum cortisol of 15.8 µg/dL (range, 6.9 to 27 µg/dL) after a median of 38 hours (range, 26 to 134 hours).

Conclusions:

A standardized continuous intravenous etomidate infusion protocol is a safe and effective means of achieving a serum cortisol level of 10 to 20 µg/dL in patients with severe hypercortisolemia.

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