• Nicole Mettauer and Joe Brierley.
• Pediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital for Children, London, United Kingdom. nmettauer@bluewin.ch
• Pediatr Crit Care Me. 2009 May 1;10(3):e37-40.

ObjectiveTo describe a novel use for etomidate in critically ill children. Etomidate induction of anesthesia in children is controversial due to adrenal suppression; we review this controversy and describe a therapeutic application of this "side effect" using a continuous etomidate infusion in pediatric intensive care to deliberately suppress critically elevated endogenous cortisol.DesignCase report.SettingA tertiary pediatric intensive care unit.PatientA 6-year-old boy with severe, life-threatening hypercortisolemia secondary to Cushing's disease.InterventionsAdmission to pediatric intensive care unit, before bilateral adrenalectomies, to facilitate etomidate infusion to reduce endogenous hypercortisolemia, as first-line treatment with metyrapone and ketoconazole had failed.Measurement And Main ResultsContinuous intravenous etomidate at 0.08 mg/kg/hr decreased serum cortisol from 1200 to 250 nmol/L within 48 hours. Once etomidate and hydrocortisone therapy provided stable serum cortisol levels, bilateral laparoscopic adrenalectomies were undertaken. A perioperative cortisol surge was seen, but to a much lower peak than expected without prior etomidate suppression.ConclusionsThe adrenal suppression caused by etomidate, so controversial in the care of the critically ill at present, can be therapeutically used for short-term control of severe hypercortisolemia in children.

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