Possible Interaction: Etomidate and Adrenocorticotropic Hormone

“While there was spontaneous recovery in the Diprivan group after 2 h combined with a positive overshooting response to ACTH stimulation, in the … could not be stimulated; it normalized slowly during the following 24 h. The 17 alpha-OH-progesterone increase was significant in the etomidate groups … of ACTH.”

“ ACTH and beta-endorphin levels increased in patients receiving etomidate , presumably as a result of the interruption of negative feedback due to cortisol synthesis inhibition.”

“The cortisol decrease from 12.5 +/- 1.7 to 7.6 +/- 1.5 caused by midazolam was similar to that following etomidate, but the response to exogenous ACTH was significantly impaired in patients receiving etomidate as compared to those receiving midazolam.”

“During the infusion of etomidate , a significant increase in the peripheral concentration of ACTH occurred, while plasma cortisol concentrations decreased.”

“Four surgical patients receiving etomidate during their operations were all found to have adrenal suppression four hours after the operation; mean (+/- S.D.) increases in cortisol and aldosterone after ACTH stimulation were only 1.8 +/- 0.5 micrograms per deciliter and 0.5 +/- 1.1 ng per deciliter, respectively.”

“Etomidate-exposed patients treated with hydrocortisone had fewer ventilator days (p < 0.001).ConclusionsAmong the patients enrolled in the study, etomidate did not alter basal cortisolemia, but it did decrease reactivity to corticotropin.”

“There was a correlation between time from etomidate injection to inclusion in the study and sensitivity to corticotropin (R2 = 0.19; p = 0.001).”

“Although cortisol increases with exogenous ACTH, levels were lower in sepsis than in nonsepsis patients, and etomidate was associated with diminished increases in cortisol with exogenous ACTH , so that its use increased, albeit nonsignificantly, low cortisol increases to exogenous ACTH from 38% to 57%, in both conditions.”

“In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate.”

“The proportion of non-responders to corticotropin was significantly higher in patients who were given etomidate in the 72 h before trial inclusion than in other patients (61.0 vs. 44.6%, P = 0.004).”

“8 The same authors re-analysed these and more contemporary data, and showed that the apparent differences in both cortisol levels, and also the ratio of ACTH to cortisol, are dramatically attenuated when etomidate use is factored in.”

“In the group of patients who received etomidate (n = 10), cortisol and aldosterone responses to adrenocorticotrophic hormone were blunted, while 11 de‐oxycortisol response was increased, as compared to a control group (n = 10).”

“The results showed that etomidate infusion (median 28.5 ug/kg/min) completely blocked the adrenocortical response to corticotropin stimulation for at least 24 h after surgery.”