scholarly journals Practical aspects of etomidate use in the management of hypercortisolaemia

2012 ◽  
Vol 167 (5) ◽  
pp. 729 ◽  
Author(s):  
Veronica A Preda ◽  
Ashley B Grossman
Keyword(s):  
Side Effects ◽  
Propylene Glycol ◽  
Cushing’S Syndrome ◽  
Dose Regimen ◽  
Cushing's Syndrome ◽  
Ease Of Use ◽  
Recommended Dose ◽  
Lipid Formulation ◽  
Starting Dose

We appreciate the letter from of Dr Soh et al. regarding our review on the use of etomidate in the treatment of Cushing's syndrome. We note that in their experience, our recommended dose regimen of 2.5 mg/h or thereabouts appears to be a safe and effective starting dose in most patients, and we note the utility and ease of use of the lipid formulation and its relative freedom from side effects compared with the more commonly used propylene glycol formulation; these are very helpful comments. Their experience in treating a further four patients is indeed further evidence of the usefulness of this agent.

CUSHING'S SYNDROME ASSOCIATED WITH A »CORTICOTROPHIN«-PRODUCING BRONCHIAL NEOPLASM

1967 ◽  
Vol 56 (2) ◽  
pp. 321-332 ◽  
Author(s):  
J. Landon ◽  
V. H. T. James ◽  
W. S. Peart
Keyword(s):  
Side Effects ◽  
Cushing’S Syndrome ◽  
Bronchial Carcinoma ◽  
Cushing's Syndrome ◽  
Adrenal Function ◽  
Clinical Usefulness ◽  
Adrenal Hyperplasia ◽  
Melanocyte Stimulating Hormone ◽  
Bilateral Adrenal Hyperplasia ◽  
Chemical Evidence

ABSTRACT A patient is reported who developed bilateral adrenal hyperplasia and Cushing's syndrome in association with an undifferentiated bronchial carcinoma. »Corticotrophin« was demonstrated by radioimmunoassay in the tumour and its metastases and »melanocyte-stimulating hormone« by bioassay in a metastasis. Treatment with Metyrapone resulted in bio-chemical evidence of improvement but side-effects limited its clinical usefulness. The use of pituitary-adrenal function tests in distinguishing patients with this syndrome from those with Cushing's disease is discussed.

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

2001 ◽  
Vol 86 (9) ◽  
pp. 4104-4108 ◽  
Author(s):  
Jonathan Krakoff ◽  
Christian A. Koch ◽  
Karim Anton Calis ◽  
R. H. Alexander ◽  
Lynnette K. Nieman
Keyword(s):  
Propylene Glycol ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Ectopic Cushing’S Syndrome ◽  
Term Management

Aminoglutethimide and metyrapone in the management of Cushing's syndrome

1985 ◽  
Vol 109 (4) ◽  
pp. 451-457 ◽  
Author(s):  
M. Thorén ◽  
U. Adamson ◽  
H. E. Sjöberg
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Cushing’S Syndrome ◽  
Adjunctive Therapy ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Ectopic Acth Syndrome ◽  
Adrenocortical Cancer ◽  
Ectopic Acth ◽  
Cortisol Excretion

Abstract. Fifteen patients with endogenous Cushing's syndrome were treated with metyrapone and/or aminoglutethimide. The duration of the therapy varied from 19 up to 365 days. In patients with Cushing's disease, metyrapone (0.5–2.5 g/day) and aminoglutethimide (0.5–1.5 g/day) seemed equally effective in reducing the cortisol excretion (54 ± 9 vs 40 ± 7%). The majority of these patients also showed a clinical improvement. In 1 patient with adrenal adenoma, metyrapone induced a remission. In another patient with adrenocortical cancer, and in 2 with the ectopic ACTH syndrome, the cortisol excretion was significantly reduced by the combination of metyrapone and aminoglutethimide but no obvious clinical improvement was observed. Side effects i.e. rash and pruritus attributed to aminoglutethimide was seen in 3 patients which necessitated the omission of treatment in 2. On metyrapone a moderate hypertrichosis was observed in 1 patient. In conclusion both metyrapone and aminoglutethimide were useful as adjunctive therapy in Cushing's syndrome.

scholarly journals Approach to the Patient Treated with Steroidogenesis Inhibitors

2021 ◽  
Author(s):  
Frederic Castinetti ◽  
Lynnette K Nieman ◽  
Martin Reincke ◽  
John Newell-Price
Keyword(s):  
Side Effects ◽  
Cushing’S Syndrome ◽  
Biological Markers ◽  
Dose Schedule ◽  
Cushing's Syndrome ◽  
Dose Titration ◽  
Biochemical Control ◽  
Treatment Dose ◽  
Shed Light ◽  
Rapid Treatment

Abstract Steroidogenesis inhibitors can be given to control the hypercortisolism of Cushing’s syndrome in various situations: when surgery has been unsuccessful or not possible; in metastatic ACTH or cortisol-secreting tumors; when waiting for the maximal efficacy of radiation techniques; for rapid treatment of severe hypercortisolism in patients with occult ACTH-producing tumors; or as a presurgical treatment in patients with severe comorbidities. Whilst biochemical ‘control’ can be achieved in more than 50% cases, daily management of such drugs can be challenging. Indeed, with a ‘dose-titration’ or a ‘block and replace’ approach, defining eucortisolism is usually difficult, requiring measurement of several biological markers. Moreover, each drug has its own side effects, which must be monitored closely. The aim of this “Approach to the patient” is to shed light on the management of hypercortisolism with four steroidogenesis inhibitors (ketoconazole, levoketoconazole, metyrapone, osilodrostat) to help the endocrinologists dealing with patients with Cushing’s syndrome. Various points will be discussed such as initial dose of treatment, dose schedule, monitoring of efficacy and side effects of monotherapy. The combination of steroidogenesis inhibitors will also be discussed.

DRUG CONTROL OF CUSHING'S SYNDROME

1976 ◽  
Vol 82 (2) ◽  
pp. 330-341 ◽  
Author(s):  
D. F. Child ◽  
C. W. Burke ◽  
D. M. Burley ◽  
Lesley H. Rees ◽  
T. Russell Fraser
Keyword(s):  
Side Effects ◽  
Cushing’S Syndrome ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Term Treatment ◽  
Ectopic Acth Syndrome ◽  
Ectopic Acth ◽  
Long Term Treatment ◽  
Dose Trial

ABSTRACT Eighteen patients with Cushing's syndrome (16 pituitary-dependent Cushing's disease, 1 ectopic ACTH syndrome, 1 primary adrenal adenoma) were given a combination of aminoglutethimide and metyrapone, with the object of controlling cortisol overproduction using less toxic doses than would be required with each drug alone. A preliminary trial of this combination using doses of aminoglutethimide of 1 g or more a day was assessed over 2 weeks. Control of cortisol overproduction and clinical improvement was achieved but side effects led to withdrawal of the drugs in 6 out of the 12 patients. A lower dose trial of this combination over 2 weeks, using 750 mg/day of aminoglutethimide also controlled cortisol overproduction and side effects led to drug withdrawal in only 2 out of 6 patients. Four of these patients were successfully controlled with even lower doses (500-750 mg/day of aminoglutethimide) for longer periods (26 days–1 year). This low regimen which consists of aminoglutethimide 500–750 mg daily, metyrapone 2 g daily, dexamethasone 0.5 mg b. d. and fludrocortisone 0.1 mg daily, is useful for preparing patients for operative treatments and may be used as a long-term treatment of milder cases.

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