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Emergency and Prolonged Use of Intravenous Etomidate to Control Hypercortisolemia in a Patient with Cushing’s Syndrome and Peritonitis

Departments of Endocrinology, Clinical Biochemistry (L.A.P.), Intensive Care (C.J.H.), Pathology (D.G.L.), and Diagnostic Imaging (R.H.R.), St. Bartholomew’s Hospital, London, United Kingdom EC1A 7BE

Address all correspondence and requests for reprints to: Dr. W. M. Drake, Department of Endocrinology, St. Bartholomew’s Hospital, West Smithfield, London, United Kingdom EC1A 7BE. E-mail: w.m.drake{at}mds.qmw.ac.uk

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.

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