Etomidate in the Treatment of Severe Cushing Syndrome: The Sri Lankan Experience

Background: Severe Cushing syndrome is a medical emergency requiring immediate supportive and hypocortisolaemic therapy. Urgent treatment of hypercortisolaemia within 24 – 72 hours is recommended to prevent life-threatening complications. Etomidate is the only intravenous option and has the most rapid onset of action out of the drugs used in treating Cushing syndrome.
Methods: We present a descriptive retrospective study of 9 patients with severe Cushing syndrome treated with Etomidate infusion at six different hospitals with Endocrine Units in Sri Lanka.
Results: On analysis Etomidate used as first-line showed a drop of cortisol of 71%, a mean rate of reduction of cortisol of 104.3 nmol/l/hour, and a duration for cortisol to reach the desired level of 15 hours Low dose Etomidate infusion did not cause adrenal insufficiency irrespective of giving a bolus prior to infusion, but caused adrenal insufficiency only when the Etomidate infusion was commenced at a higher rate.
Conclusion: We conclude that Etomidate is potentially a suitable first line treatment in severe Cushing syndrome, especially in a resource poor setting where other therapeutic agents are not accessible