Etomidate Can Be Used to Treat Severe Cortisol Excess, Study Shows

A study reports that intravenous infusion with etomidate can stabilize dangerously high cortisol in Cushing’s syndrome patients experiencing episodes of cortisol excess.

The study, “Continuous Etomidate Infusion for the Management of Severe Cushing Syndrome: Validation of a Standard Protocol,” was published in Journal of the Endocrine Society.

Cushing’s syndrome occurs when the body creates too much of the stress hormone cortisol. For most patients, the disease progresses relatively slowly, and can take a while to be diagnosed.

However, in some cases, Cushing’s can manifest as a medical emergency where cortisol levels rapidly rise, which can be life threatening. Episodes of hypercortisolemia (elevated cortisol levels) can be difficult for clinicians to control; some therapies have a success rate of only 50% and can lead to liver problems.

Etomidate, marketed as Amidate, is a drug that has been used since the 1970s as a relaxant during the placement of tubes in the throat. It has also been shown to rapidly lower cortisol levels; its structure is similar to that of ketoconazole, a drug that acts on the adrenal gland and can be used to control cortisol levels.

“Etomidate is widely available and can be easily used in an intensive care unit setting,” the researchers noted.

In the study, the investigators reviewed data from nine episodes of hypercortisolemia that had been treated with intravenous administration of etomidate at their hospital.

In eight of the nine episodes, cortisol levels were reduced to a target concentration of 20 micrograms per deciliter — the average cortisol levels during the episodes were over 100. On average, cortisol levels were reduced by 80% over the course of about two days.

Infusion with etomidate was well-tolerated; most patients had minimal side effects. Two experienced nausea and vomiting toward the end of etomidate, which was likely a response to rapid changes in the stress hormone. Also, one patient’s hypercortisolemia-induced psychosis was alleviated by etomidate treatment; none exhibited signs of sedation or abnormal mental status.

Although noting that the study is limited, particularly because of the small sample size, the researchers concluded that their “protocol-driven continuous etomidate infusion demonstrated rapid control of severe hypercortisolism secondary to neoplastic Cushing syndrome without any observed adverse side effects.”