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Use of a Parenteral Propylene Glycol-Containing Etomidate Preparation for the Long-Term Management of Ectopic Cushing’s Syndrome

National Institute of Diabetes and Digestive and Kidney Diseases (J.K.), National Institutes of Health, Phoenix, Arizona 85014; and Pediatric and Reproductive Endocrinology Branch (C.A.K.), National Institute of Child Health and Human Development (C.A.K., L.K.N.); Clinical Center Pharmacy (K.A.C.); and Surgery Branch, National Cancer Institute (R.H.A.), National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Jonathan Krakoff, M.D., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, Arizona 85014. E-mail: jkrakoff{at}mail.nih.gov

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.

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