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Etomidate in Severe Cushing Syndrome: A Systematic Review.

Dimuthu Tharanga Muthukuda1, Kamani Dhanushka Liyanaarachchi2, Kushalee Poornima Jayawickreme3

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Etomidate is a safe and effective intravenous treatment for severe Cushing syndrome, particularly in critical care settings. This review highlights its efficacy in rapidly reducing cortisol levels, improving patient outcomes.

Keywords:
Cushing’s diseasecortisoletomidatehypercortisolismsevere Cushing syndrome

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Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Severe Cushing syndrome necessitates urgent intervention.
  • Etomidate is the sole intravenous option for hypercortisolism, crucial for critically ill patients unable to take oral medications.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy and safety of etomidate in treating severe Cushing syndrome.

Main Methods:

  • A systematic review and meta-analysis of 36 articles, including 76 clinical cases and 78 episodes of etomidate use.
  • Data reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main Results:

  • Etomidate was safely administered to a wide age range (2 months to 82 years).
  • Faster cortisol reduction observed with higher baseline cortisol, prior bolus dose, and higher initial infusion rates.
  • Etomidate as first-line therapy and in ICU settings showed more rapid cortisol reduction.

Conclusions:

  • Etomidate is effective and safe for lowering cortisol levels in Cushing syndrome.
  • Standardized guidelines for etomidate use in diverse clinical settings are needed to optimize safety and efficacy.