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March 26, 2026Critical Care Medicine

212: Etomidate, Ketoconazole, and Mitotane for Cushing Disease Due to Adrenocortical Carcinoma

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Authors

KDKaley DeichstetterADAndrew DeSioGBGrace Benanti

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Overview

Case report demonstrates effective cortisol reduction in Cushing’s disease due to adrenocortical carcinoma, highlighting treatment challenges.

Key Points

  • The aim is to showcase rapid cortisol reduction in a patient with Cushing's disease secondary to adrenocortical carcinoma using etomidate infusion and address associated treatment challenges.
  • Administered etomidate as a bolus and continuous infusion based on cortisol levels.
  • Titrated ketoconazole and mitotane during treatment.
  • Monitored drug-drug interactions and alterations in cortisol levels.
  • Serum cortisol decreased from 306 µg/dL to 56.6 µg/dL within 24 hours.
  • Goal cortisol levels of 20-30 µg/dL achieved after 114 hours.
  • Patient discharged to hospice care after 41 days of admission.

Cite This Study

Deichstetter et al. (2026) studied this question.

synapsesocial.com/papers/69c4cc98fdc3bde448917fb6https://doi.org/10.1097/01.ccm.0001182844.03231.d3
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 18281 Continuous Low-Dose Etomidate Infusion For The Management Of Severe Hypercortisolism In Metastatic Adrenocortical Carcinoma2024
  2. 27117 Cushings Conundrum: Taming The Hormone Hurricane2024
  3. 3Etomidate Monotherapy for Perioperative Control of Hypercortisolism in a Mitotane-Intolerant Patient With Adrenocortical Carcinoma: A Case Report2026
  4. 46702 Management And Complications Of Metastatic Adrenocortical Carcinoma Presenting With Severe Cushing Syndrome2024 · 1 citations
  5. 57162 Cushing’s Syndrome due to Metastatic Atypical Pulmonary Carcinoid and the Therapeutic Journey to Bilateral Adrenalectomy2024