Fellows I W, Bastow M D, Byrne A J, Allison S P
Br Med J (Clin Res Ed). 1983 Dec 17;287(6408):1835-7. doi: 10.1136/bmj.287.6408.1835.
Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).
三名因多处受伤入住重症监护病房的患者，经观察出现了肾上腺皮质功能不全的发作，临床表现提示了这一点，并通过适当降低的皮质醇浓度得到证实。这促使对六名多处受伤患者的垂体 - 肾上腺皮质功能进行前瞻性研究，其中三名患者显示出肾上腺皮质抑制的证据。肾上腺皮质功能异常低下的六名患者唯一的共同因素是肾上腺皮质抑制期与依托咪酯静脉输注之间的关联；当药物停用后，肾上腺皮质功能恢复，再次给药会导致进一步抑制。发现仅持续六小时的依托咪酯输注会导致对短程二十四肽促皮质素试验的反应低下、平坦，以及促肾上腺皮质激素的血浆浓度大幅升高，提示对肾上腺皮质有直接抑制作用。与未接受依托咪酯的三名患者相比，前瞻性研究的接受依托咪酯输注的三名患者在上午9点测得的血浆皮质醇浓度中位数显著更低，而上午9点测得的促肾上腺皮质激素血浆浓度中位数显著更高（p = 0.05）。
