Etomidate in severe hypercortisolism: early cortisol kinetics and clinical outcomes in a real-world cohort
Authors' conclusion
In this real-world cohort of patients with severe hypercortisolism, low-dose intravenous etomidate was associated with early cortisol reduction and clinically useful biochemical control in most patients.
Study context
- Population
- Consecutive patients with severe endogenous hypercortisolism treated with IV etomidate at a tertiary care centre over 3 years; median baseline cortisol 1285 nmol/L (46.6 µg/dL)
- Participants
- 10 patients
- Outcome
- Early response: biochemical control (serum cortisol < 500 nmol/L (< 18.1 µg/dL))
- Follow-up
- 12 and 24 h
Methodological detailssingle-centre, consecutive patients, tertiary care centre
- Single-centre
- Consecutive patients
- Tertiary care centre
Main finding
As reported in the abstract
Median cortisol reduction at 12 h
45%
Median cortisol reduction at 24 h
58.5%
Biochemical control within 24 h
80%
Observational data: associations, not effects.
Further findings
Response categories
- Rapid
- 30%
- Intermediate
- 50%
- Delayed
- 20%
- Patients with < 25% cortisol reduction at 12 h tended to have delayed biochemical control
Serum potassium
- Improved during treatment and normalized before discontinuation of infusion in all patients with available serial data
Clinical stabilization
- Clinical stabilization achieved
- 90%
Safety
- Death due to sepsis, not related to therapy
- 1
- Etomidate was well tolerated
Original publication
Etomidate in severe hypercortisolism: early cortisol kinetics and clinical outcomes in a real-world cohort. Pituitary. Published 1 July 2026. doi:10.
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