Emergency and prolonged use of intravenous etomidate to control hypercortisolemia in a patient with Cushing's syndrome and peritonitis

J Clin Endocrinol Metab. 1998 Oct;83(10):3542-4. doi: 10.1210/jcem.83.10.5156.

Abstract

We report the emergency and prolonged use of etomidate to control circulating cortisol levels in a patient with Cushing's syndrome secondary to ectopic ACTH production from a pancreatic islet cell tumor. Duodenal perforation and peritonitis complicated an episode of salmonella septicemia, precluding the use of conventional oral medical adrenolytic therapy. Endogenous cortisol secretion was abolished by parenteral etomidate, allowing serum cortisol levels to be controlled with an iv infusion of hydrocortisone over an 8-week period in intensive care before definitive pancreatic surgery.

Publication types

  • Case Reports

MeSH terms

  • Adenoma, Islet Cell / metabolism
  • Adenoma, Islet Cell / surgery
  • Adrenocorticotropic Hormone / metabolism
  • Adult
  • Cushing Syndrome / blood*
  • Cushing Syndrome / complications
  • Cushing Syndrome / etiology
  • Emergency Medical Services*
  • Etomidate / administration & dosage*
  • Etomidate / therapeutic use
  • Humans
  • Hydrocortisone / antagonists & inhibitors
  • Hydrocortisone / blood*
  • Hydrocortisone / therapeutic use
  • Injections, Intravenous
  • Male
  • Pancreatic Neoplasms / metabolism
  • Pancreatic Neoplasms / surgery
  • Peritonitis / complications*
  • Preoperative Care

Substances

  • Adrenocorticotropic Hormone
  • Hydrocortisone
  • Etomidate