title: Use of intravenous etomidate to control acute psychosis induced by the hypercortisolaemia in severe paediatric Cushing's disease.
abstract: BACKGROUND
  Psychosis secondary to paediatric Cushing's disease (CD) is extremely rare and presents a significant management challenge.
  
  
  METHODS
  We report a 14.7-year-old CD patient with acute psychosis and self-inflicted injuries following failed transsphenoidal pituitary surgery. Her mental state rapidly deteriorated precluding medical therapy.
  
  
  RESULTS
  Emergency intravenous low-dose etomidate infusion (3-3.5 mg/h) with dose titration according to the serum cortisol combined with a hydrocortisone infusion, in an intensive care setting, was effective in controlling the hypercortisolaemia. Her mental state improved with normalisation of her cortisol levels enabling oral administration of ketoconazole and bilateral adrenalectomy to be performed.
  
  
  CONCLUSIONS
  This case illustrates the safe and effective use of a low-dose etomidate infusion in an unusual case of paediatric CD.
authors: Paediatric Endocrinology, Barts and the London School of Medicine and Dentistry, London, UK.
authors: L F
authors: LF
authors: Chan
authors: M
authors: M
authors: Vaidya
authors: B
authors: B
authors: Westphal
authors: J
authors: J
authors: Allgrove
authors: L
authors: L
authors: Martin
authors: F
authors: F
authors: Afshar
authors: P C
authors: PC
authors: Hindmarsh
authors: M O
authors: MO
authors: Savage
authors: A B
authors: AB
authors: Grossman
authors: H L
authors: HL
authors: Storr
mesh_terms: D000293:Adolescent; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D003480:Cushing Syndrome / Q000150:complications*; D005045:Etomidate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000150:complications*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology*; D016728:Self-Injurious Behavior / Q000209:etiology
chemical_list: D018686:Anesthetics, Intravenous; D005045:Etomidate