Etomidate causes adrenocortical suppression by producing a dose-dependent inhibition of the conversion of cholesterol to cortisol. This is known as Etomidate adrenal suppression
Cortisol and aldosterone are depressed by etomidate, but the clinical relevance is minimal after a single bolus injection. Etomidate adrenal suppression causes a specific and reversible blockade of the 11 beta-hydroxylation of adrenal steroid synthesis as evidenced by the accumulation of 1 1-deoxycorticosterone and 1 1-deoxycortisol.
Plasma ACTH concentrations also rise due to etomidate. Therefore, etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects.
The incidence of relative adrenal insufficiency in patients with septic shock is increased.