Endocrine Abstracts

Background: Etomidate is mainly used in general anesthesia. In some rare cases it can also be helpful in treating life-thretening severe hypercortisolaemia (in much lower doses) in patients who are not able to take oral medications or when oral drugs are not available.

Case Presentation: Fifty-seven-year-old woman with symptoms of virilization, hypokalemia and muscle weekness for 6 months was admitted to Department of Endocrinology. On admission cortisol concentration was extremely high (64 ug/dl) with ACTH level 662 pg/ml. Androstendione and testosterone concentrations were 4-fold above upper limit of normal. Test using Corticotropin-releasing hormone indicated on an ectopic source of ACTH. Repeated twice whole body CT, MRI of hypophysis and somatostatin receptor scintigraphy did not reveal any tumors. Meantime, due to the lack of ketoconazol and metopirone, etomidate intravenously was administered in the initial dose of 2.5 mg in bolus, and infusion was continued at 0.5–1 mg/h, adjusted to the cortisol levels. Decrease in cortisol levels was observed and the concentration was maintained at about 10–12 ug/dl. Simultaneously with etomidate administration the patient developed S. aureus (MSSA) sepsis of unknown origin. Eventually she was treated with several antibiotics, also due to hospital-aquired urinary tract infections. After three months of treatment with antibiotics and etomidate, when patient condition was improved, bilateral adrenalectomy was perfomed as no source of ACTH excess was found.

Conclusions: Etomidate is usefull and valuable hypocortisolaemic agent in case of severe Cushing syndrome. Its action is potent, immediate and well-tolerated, thus should be considered in selected cases.