Continuous Etomidate Infusion for the Management of Severe Cushing Syndrome: Validation of a Standard Protocol. J Endocr Soc 2019 Jan 01;3(1):1-12
Date
12/19/2018Pubmed ID
30560224Pubmed Central ID
PMC6291660DOI
10.1210/js.2018-00269Scopus ID
2-s2.0-85066048597 (requires institutional sign-in at Scopus site) 36 CitationsAbstract
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.
Author List
Carroll TB, Peppard WJ, Herrmann DJ, Javorsky BR, Wang TS, Patel H, Zarnecki K, Findling JWAuthors
Ty Carroll MD Associate Professor in the Medicine department at Medical College of WisconsinJames W. Findling MD Professor in the Medicine department at Medical College of Wisconsin
Bradley R. Javorsky MD Associate Professor in the Medicine department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
