Muthukuda et al.JES.Supplementary file 1 and 2.xlsx

Severe Cushing syndrome is a medical emergency Etomidate is the only intravenous option available for treating hypercortisolism, especially in critically ill patients obviating oral medications. A Systematic review and meta-analysis were conducted on the use of etomidate in the treatment of severe Cushing syndrome. This was registered in PROSPERO and data reporting was done as per the PRISMA guidelines. Thirty-six published articles comprising 76 clinical cases of 78 clinical episodes of etomidate use were included in the analysis for this review. Etomidate was administered safely to patients of ages ranging from 2 months to 82 years. Faster cortisol reduction rates were observed in patients with higher baseline cortisol levels, those receiving a prior bolus dose, and those given higher initial infusion rates. Etomidate as first-line therapy and ICU settings were associated with more rapid cortisol reduction compared to its use as subsequent therapy or in non-ICU settings. Etomidate is effective and safe for reducing cortisol levels in Cushing syndrome.