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Efficient short-term control of hypercortisolaemia by low-dose etomidate in severe paediatric Cushing's disease

J E Greening1, C E Brain, L A Perry

  • 1Department of Paediatric, St. Bartholomew's and the Royal London Hospitals, London, UK.

Hormone Research
|September 30, 2005
PubMed

Insights

This study shows etomidate effectively controlled severe hypercortisolaemia in a pediatric Cushing's disease patient when other treatments failed. The drug provided safe, short-term cortisol management before surgery.

Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine

Background:

  • Paediatric Cushing's disease (CD) is a rare but serious condition requiring effective hypercortisolaemia management.
  • Pre-surgical control of hypercortisolaemia is crucial for optimal outcomes in pediatric CD.
  • This case highlights the challenges in managing severe hypercortisolaemia in a critically ill child.

Observation:

  • A 6.2-year-old male presented with severe hypercortisolaemia and life-threatening complications of Cushing's disease.
  • Metyrapone and ketoconazole were ineffective in controlling cortisol levels.
  • The patient's deteriorating condition necessitated an alternative treatment approach.

Findings:

  • Low-dose intravenous etomidate infusion effectively reduced serum cortisol from 1,250 to 250 nmol/l within 24 hours.
  • Combined etomidate and hydrocortisone therapy stabilized serum cortisol levels for 12 days.
  • Bilateral adrenalectomy was successfully performed following etomidate-induced cortisol control.

Implications:

  • Etomidate offers a safe and effective option for short-term management of severe hypercortisolaemia in pediatric patients.
  • This approach can stabilize critically ill children with Cushing's disease, facilitating definitive surgical treatment.
  • Further research into etomidate's role in pediatric endocrine emergencies is warranted.
Abstract

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