Adrenocortical function in critically ill patients 24 h after a single dose of etomidate

Anaesthesia. 1999 Sep;54(9):861-7. doi: 10.1046/j.1365-2044.1999.01003.x.


We compared the effects of single doses of etomidate and thiopentone on adrenocortical function in a randomised controlled clinical trial involving 35 critically ill patients who needed a general anaesthetic. Just before induction of anaesthesia, a baseline blood cortisol sample was taken. Twenty-four hours later we performed a short adrenocorticotrophic hormone stimulation test. No patient had a low cortisol level (< 160 nmol.l-1) at any time during the study. Baseline, pre-ACTH and post-ACTH cortisol levels were similar in the two groups. However, significantly more patients in the etomidate group had an ACTH-stimulated cortisol increment < 200 nmol.l-1. The clinical significance of these findings is not clear, but we conclude that single doses of etomidate may interfere with cortisol synthesis for at least 24 h in the critically ill.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adrenal Cortex / drug effects*
  • Adrenal Cortex / physiopathology
  • Adrenal Cortex Function Tests
  • Adrenocorticotropic Hormone
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, General
  • Anesthetics, Intravenous / pharmacology*
  • Critical Care
  • Critical Illness / therapy*
  • Etomidate / pharmacology*
  • Female
  • Hospital Mortality
  • Humans
  • Hydrocortisone / blood
  • Male
  • Middle Aged
  • Thiopental / pharmacology


  • Anesthetics, Intravenous
  • Adrenocorticotropic Hormone
  • Thiopental
  • Hydrocortisone
  • Etomidate