title: Nonhypnotic low-dose etomidate for rapid correction of hypercortisolaemia in Cushing's syndrome.
abstract: We determined the adrenostatic potential of low-dose nonhypnotic etomidate in six patients with Cushing's syndrome (ectopic Cushing's syndrome, n = 2; Cushing's disease, n = 3; bilateral adrenal adenoma, n = 1). Etomidate was given as a continuous infusion for 32 h in a dose of 2.5 mg/h (n = 5) or 0.3 mg/kg/h (n = 3), respectively. Saline was given during a control period. The responsiveness to exogenous ACTH was studied during placebo and 7 and 31 h after commencing etomidate by administration of 250 micrograms 1-24 ACTH i.v. Etomidate (2.5 mg/h) led to a consistent decrease in serum cortisol in all patients from a mean of 39.4 +/- 13.3 to 21.1 +/- 5.7 micrograms/dl after 7 h (P less than 0.05 compared with placebo). After 24 h cortisol was reduced further to a mean steady state concentration of 12.3 +/- 5.7 micrograms/dl (P less than 0.05). At the end of the infusion period the cortisol increase in response to ACTH was reduced but not abolished. In contrast, a dose of 0.3 mg/kg/h etomidate induced unresponsiveness of serum cortisol to exogenous ACTH within 7 h. However, sedation was observed in two out of three patients at this dose, while during etomidate in a dose of 2.5 mg/h no side effects were seen. We conclude that low-dose nonhypnotic etomidate reduces serum cortisol to within the normal range in patients with Cushing's syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Medizinische Universitätsklinik II, Köln-Merheim.
authors.forename: B
authors.initials: B
authors.lastname: Allolio
authors.forename: H M
authors.initials: HM
authors.lastname: Schulte
authors.forename: D
authors.initials: D
authors.lastname: Kaulen
authors.forename: M
authors.initials: M
authors.lastname: Reincke
authors.forename: C
authors.initials: C
authors.lastname: Jaursch-Hancke
authors.forename: W
authors.initials: W
authors.lastname: Winkelmann
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000097:blood / Q000188:drug therapy*; D005045:Etomidate / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D006854:Hydrocortisone; D005045:Etomidate