Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients.

Vinclair M, Broux C, Faure P, Brun J, Genty C, Jacquot C, Chabre O, Payen JF

Department of Anesthesiology and Critical Care, Albert Michallon Hospital, BP 217, 38043, Grenoble, France.

OBJECTIVE: To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients. DESIGN: Prospective, observational cohort study. SETTING: Three intensive care units in a university hospital. PATIENTS: Forty critically ill patients without sepsis who received a single dose of etomidate for facilitating endotracheal intubation. MEASUREMENTS AND MAIN RESULTS: Serial serum cortisol and 11beta-deoxycortisol samples were taken at baseline and 60[Symbol: see text]min after corticotropin stimulation test (250[Symbol: see text]mug 1-24 ACTH) at 12, 24, 48, and 72[Symbol: see text]h after etomidate administration. Etomidate-related adrenal inhibition was defined by the combination of a rise in cortisol less than 250[Symbol: see text]nmol/l (9[Symbol: see text]mug/dl) after ACTH stimulation and an excessive accumulation of serum 11beta-deoxycortisol concentrations at baseline. At 12[Symbol: see text]h after etomidate administration, 32/40 (80%) patients fulfilled the diagnosis criteria for etomidate-related adrenal insufficiency. This incidence was significantly lower at 48[Symbol: see text]h (9%) and 72[Symbol: see text]h (7%). The cortisol to 11beta-deoxycortisol ratio (F/S ratio), reflecting the intensity of the 11beta-hydroxylase enzyme blockade, improved significantly over time. CONCLUSIONS: A single bolus infusion of etomidate resulted in wide adrenal inhibition in critically ill patients. However, this alteration was reversible by 48[Symbol: see text]h following the drug administration. The empirical use of steroid supplementation for 48[Symbol: see text]h following a single dose of etomidate in ICU patients without septic shock should thus be considered. Concomitant serum cortisol and 11beta-deoxycortisol dosages are needed to provide evidence for adrenal insufficiency induced by etomidate in critically ill patients.

Published 24 March 2008 in Intensive Care Med, 34(4): 714-9.
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