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Review
. 2022 Dec;21(4):735-742.
doi: 10.1007/s42000-022-00397-4. Epub 2022 Sep 21.

Cushing's syndrome: a combined treatment with etomidate and osilodrostat in severe life-threatening hypercortisolemia

Lukasz Dzialach  1 , Joanna Sobolewska  2 , Wioleta Respondek  3 , Agnieszka Wojciechowska-Luzniak  1 , Przemyslaw Witek  1
Affiliations
Review

Cushing's syndrome: a combined treatment with etomidate and osilodrostat in severe life-threatening hypercortisolemia

Lukasz Dzialach et al. Hormones (Athens). 2022 Dec.

Abstract

Endogenous Cushing's syndrome (CS) is associated with increased morbidity and mortality. Early diagnosis and initiation of therapy are essential, but effective treatment remains a challenge. In a long-term follow-up, biochemical control of hypercortisolemia, especially when severe, is difficult to achieve. Life-threatening hypercortisolemia is difficult to control due to the limitations of pharmacotherapy, including its side effects, and may require etomidate infusion in the intensive care unit (ICU) to rapidly lower cortisol levels. The effectiveness of hypercortisolemia management can be increased by a dual blockade of cortisol production. We report the efficacy, safety, and tolerability of combined therapy with two steroidogenesis inhibitors, etomidate, and osilodrostat, in a 32-year-old woman diagnosed with severe ACTH-dependent hypercortisolemia, subsequently maintaining a stable level of cortisol with osilodrostat monotherapy. This approach enabled achievement of relatively rapid control of the hypercortisolemia while using an etomidate infusion and concomitant increasing doses of oral osilodrostat applying a "titrations strategy." Our experience shows that it is worth taking advantage of the synergistic anticortisolic action of etomidate with osilodrostat.

Keywords: Cortisol; Cushing’s syndrome; Etomidate; Osilodrostat; Severe hypercortisolemia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Evolution of serum cortisol levels during treatment with the osilodrostat and etomidate dosing regimen. Cortisol values are the average of 3–8/day time measurements (depending on the day). The shaded area corresponds to the cortisol reference range
Fig. 2
Fig. 2
Evolution of potassium levels during treatment with the osilodrostat and etomidate dosing regimen. Potassium values are the mean of 1–8/day time measurements (depending on the day). The shaded area corresponds to the potassium reference range
Fig. 3
Fig. 3
Frontal and sagittal MRI demonstrating a normal pituitary without signs of microadenoma in the presented patient: a Frontal T1-weighted pre-contrast scan. b Frontal T1-weighted post-contrast scan. c Sagittal T1-weighted pre-contrast scan. d Sagittal T1-weighted post-contrast scan
See this image and copyright information in PMC

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