title: Use of a parenteral propylene glycol-containing etomidate preparation for the long-term management of ectopic Cushing's syndrome.
abstract: Chronic severe hypercortisolism is associated with life-threatening infections, diabetes and a high surgical mortality rate. Oral medical therapy can inhibit steroidogenesis and reduce the risk of these complications. However, apart from a few reports using an ethyl alcohol formulation of the iv anesthetic etomidate, there is no well-tested parenteral steroidogenesis inhibitor. We used the propylene glycol preparation of etomidate available in the United States to control hypercortisolism in a 39-yr-old man with ectopic ACTH secretion who was unable to take oral medications. Etomidate was administered over a period of 5.5 months. We titrated the dose of etomidate daily using serum cortisol levels, to avoid steroid over replacement and allow for a response to ongoing stress. A reduced dose during a period of acute renal failure achieved adequate control of hypercortisolemia. Suppression of steroidogenesis persisted for at least 14 d and perhaps as long as 6 wk after cessation of the medication. Except for transient myoclonus, the patient tolerated this preparation well. Parenteral propylene glycol containing etomidate can be used safely for a prolonged period to reduce hypercortisolemia in patients unable to take oral medications.
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona 85014, USA. jkrakoff@mail.nih.gov
authors.forename: J
authors.initials: J
authors.lastname: Krakoff
authors.forename: C A
authors.initials: CA
authors.lastname: Koch
authors.forename: K A
authors.initials: KA
authors.lastname: Calis
authors.forename: R H
authors.initials: RH
authors.lastname: Alexander
authors.forename: L K
authors.initials: LK
authors.lastname: Nieman
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000097:blood; D000311:Adrenal Glands / Q000187:drug effects; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003480:Cushing Syndrome / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D004337:Drug Carriers; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007262:Infusions, Intravenous; D008297:Male; D011409:Propylene Glycols
chemical_list: D000305:Adrenal Cortex Hormones; D018686:Anesthetics, Intravenous; D004337:Drug Carriers; D011409:Propylene Glycols; D006854:Hydrocortisone; D005045:Etomidate