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首页> 外文期刊>Therapeutic advances in endocrinology and metabolism. >Low-dose etomidate for the management of severe hypercortisolaemia in different clinical scenarios: a case series and review of the literature
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Low-dose etomidate for the management of severe hypercortisolaemia in different clinical scenarios: a case series and review of the literature

机译：低剂量依托咪酯在不同临床情况下治疗严重高皮质醇血症的病例系列和文献综述

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Severe Cushing’s syndrome (SCS) is associated with acute cardiovascular, metabolic and infectious complications. It is considered an emergency, requiring an immediate diagnosis, together with a broad spectrum of supportive and hypocortisolaemic treatments. Surgical intervention, aimed at removing the source of cortisol or adrenocorticotropic hormone (ACTH), is the optimal treatment in most cases of Cushing’s syndrome. However, in hypercortisolaemic states, surgical intervention has high rates of perioperative mortality and morbidity. Oral adrenal steroidogenesis inhibitors, even if more effective in combination, are not always efficient enough or well tolerated. Despite their common use, a more potent, parental, immediate, and thus life-saving, therapy is necessary. The authors present three different clinical scenarios of etomidate treatment in patients hospitalized in the third reference endocrinological centre in Poland between 2016 and 2017. Patients with Cushing’s disease, ectopic Cushing’s syndrome and adrenocortical carcinoma presented with severe hypercortisolaemia and exacerbated cortisol-dependent comorbidities. In these three cases, etomidate acted as an accurate, well tolerated and effective cortisol-lowering drug for several days or even months. Patients were monitored in a general ward setting, and no side effects of the therapy were observed. In doses far lower than those used for anaesthesia, etomidate works as a useful cortisol-lowering therapy in patients intolerant to or unable to take oral medications. Additionally, if urgent, the most potent and effective medical intervention is necessary, and clinicians should be aware of such a therapeutic option.
机译：严重库欣综合症（SCS）与急性心血管，代谢和传染性并发​​症相关。它被认为是紧急情况，需要立即诊断，以及广泛的支持和皮质醇治疗。在大多数库欣综合症病例中，旨在消除皮质醇或促肾上腺皮质激素（ACTH）来源的手术干预是最佳治疗方法。然而，在高皮质素血症状态下，手术干预的围手术期死亡率和发病率很高。口服肾上腺类固醇生成抑制剂，即使联合使用更有效，也不总是足够有效或耐受良好。尽管有普遍用途，但仍需要一种更有效的，家长式的，即刻治疗的方法，从而挽救生命。作者介绍了2016年至2017年间在波兰第三参考内分泌中心住院的患者依托咪酯治疗的三种不同临床情况。库欣病，异位库欣综合症和肾上腺皮质癌患者表现出严重的高皮质醇血症和加重了皮质醇依赖的合并症。在这三种情况下，依托咪酯在数天甚至数月内一直是一种准确，耐受性良好且有效的皮质醇降低药物。在普通病房中对患者进行了监测，未观察到该疗法的副作用。依托咪酯的剂量远低于麻醉时的剂量，可用于不能耐受或无法口服药物的患者的皮质醇降低疗法。另外，如果紧急，则需要最有效和有效的医学干预，临床医生应意识到这种治疗选择。

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