Using Etomidate in a Two-month-old Infant with Cushing Syndrome due to Adrenocortical Carcinoma
Ahreum Kwon,
youngha choi,
Jo Won Jung,
Junghwan Suh,
Ho-Seong Kim
Affiliations
Ahreum Kwon
Division of Pediatric Endocrinology, Severance Children's Hospital, Department of Pediatrics, Institute of Endocrinology, Yonsei University College of Medicine, Seoul, Korea
youngha choi
Division of Pediatric Endocrinology, Severance Children's Hospital, Department of Pediatrics, Institute of Endocrinology, Yonsei University College of Medicine, Seoul, Korea
Jo Won Jung
Division of Pediatric Cardiology, Severance Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
Junghwan Suh
Division of Pediatric Endocrinology, Severance Children's Hospital, Department of Pediatrics, Institute of Endocrinology, Yonsei University College of Medicine, Seoul, Korea
Ho-Seong Kim
Division of Pediatric Endocrinology, Severance Children's Hospital, Department of Pediatrics, Institute of Endocrinology, Yonsei University College of Medicine, Seoul, Korea
Cushing syndrome (CS) is a rare disease caused by hypercortisolemia. Although surgical treatment is the first-line treatment in CS, the appropriate medication for the patient's condition should be selected when medical treatment is needed. Etomidate is an adrenal-blocking drug used to treat CS and the most suitable for severe hypercortisolemia and adrenocortical carcinoma (ACC), due to cardiovascular stability and an anti-tumorigenic effect. However, its use and safe recommended dosage in infants with CS is unreported. Here we describe the case of a 2-month-old girl treated with etomidate for CS caused by ACC. Even though radical mass excision was performed, severe hypercortisolemia persisted, resulting from metastatic lesions in the liver, and medical treatment was considered. The etomidate doses, no bolus dose and infusion rate of 0.03 mg/kg/hour, may be an appropriate dose for severe hypercortisolemia in infants. This case will help determine future treatment strategies for similar cases in infants.