EMERGENCY AND PROLONGED USE OF INTRAVENOUS ETOMIDATE TO CONTROL HYPERCORTISOLEMIA IN A PATIENT WITH CUSHINGS-SYNDROME AND PERITONITIS

We report the emergency and prolonged use of etomidate to control circ ulating cortisol levels in a patient with Cushings syndrome secondary to ectopic ACTH production ii om a pancreatic islet cell tumor. Duoden al perforation and peritonitis complicated an episode of salmonella se pticemia. precluding the use of conventional oral medical adrenolytic therapy. Endogenous cortisol secretion was abolished by parenteral eto midate, allowing serum cortisol levels to be controlled with an iv inf usion of hydrocortisone over an 8-week period in intensive care before definitive pancreatic surgery.