Anaes Vivas · Intravenous induction agents
Data viva — etomidate and the blocked adrenal pathway
A data viva on the adrenal steroidogenesis pathway and the site of etomidate inhibition — the blockade of 11-beta-hydroxylase (CYP11B1) and the cholesterol side-chain cleavage enzyme (CYP11A1), the consequent loss of cortisol and aldosterone for 8 to 24 hours after a single dose, and the clinical consequences in septic shock, with the pooled RCT evidence (2026 meta-analysis).
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A schematic shows the adrenal steroid synthesis pathway. Cholesterol is converted (by the cholesterol side-chain cleavage enzyme, CYP11A1) to pregnenolone, then to progesterone. The pathway then forks into two limbs: the cortisol limb (progesterone to 11-deoxycortisol to CORTISOL) and the aldosterone limb (progesterone to 11-deoxycorticosterone to corticosterone to ALDOSTERONE). The 11-beta-hydroxylase step (CYP11B1) is drawn as a blocked step on BOTH limbs and labelled ETOMIDATE. A second block is shown at the CYP11A1 step. Interpret the diagram and explain the clinical consequences.
References3ShowHide
- [1]Andriazzi VH, et al. Etomidate versus ketamine for emergency intubation. J Intensive Care Med, 2026.PMID 42299661
- [2]Zampieri FG, et al. Induction agents for emergency tracheal intubation. Crit Care, 2026.PMID 42121165
- [4]Bhattacharya O, et al. Normalization of Potassium Despite 11-Deoxycorticosterone Rise During Etomidate Therapy in Adrenocortical Carcinoma. JCEM Case Rep, 2026.PMID 41940234