Use of a parenteral propylene glycol-containing etomidate preparation for the long-term management of ectopic Cushing's syndrome

Chronic severe hypercortisolism is associated with life-threatening infecti ons, 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 ane sthetic etomidate, there is no well-tested parenteral steroidogenesis inhib itor. We used the propylene glycol preparation of etomidate available in th e United States to control hypercortisolism in a 39-yr-old man with ectopic ACTH secretion who was unable to take oral medications. Etomidate was admi nistered over a period of 5.5 months. We titrated the dose of etomidate dai ly 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 o f steroidogenesis persisted for at least 14 d and perhaps as long as 6 wk a fter cessation of the medication. Except for transient myoclonus, the patie nt tolerated this preparation well. Parenteral propylene glycol containing etomidate can be used safely for a prolonged period to reduce hypercortisol emia in patients unable to take oral medications.