Endocrine Abstracts

JOINT1596

Introduction: There is an increasing concern regarding the misuse of etomidate, a drug traditionally used as a general anaesthetic, which is now being abused within the community through vaping with electronic cigarettes. Beyond its immediate effects on the central nervous system, etomidate presents substantial risks due to its adrenal toxicity and the potential for long-term impairments in cognitive and endocrine functions. The rising prevalence of adolescent use of electronic cigarettes is also becoming a pressing issue.

Objectives and methodology: We hereby report a retrospective cohort review of all paediatric patients, who are defined as age at or below 18 years old, with etomidate detected in their urine toxicology analyses upon admissions to Princess Margaret Hospital between 1 January 2024 and 31 December 2024 inclusively.

Results: Thirteen adolescents (7 females) were identified (age 14.1–17.9 years). They reported to have vaped etomidate for an average of two months (range: 1–8 months) before presenting to the hospital. Seven of them admitted to having taken other substances. Common presenting complaints included confusion and dizziness (3/13), unsteady gait (2/13), suicidal attempt/deliberate self-harm (2/13). At presentation, five of them had hypertension (systolic blood pressure range: 94–160 mmHg). All did not manifest signs of hyperandrogenism. One patient was treated in the paediatric intensive care unit (ICU) for inhalation injuries resulting from a fire incident due to vaping. Morning cortisol was low in 3 out of 8 patients (range: 44–83; reference >133 nmol/l). Short synacthen test showed adrenal insufficiency in 3 out of 6 patients (peak cortisol range: 74–238; reference >376 nmol/l). Baseline ACTH levels were elevated in three cases (range: 28–55; reference 1.6–13.9 pmol/l). Renin and aldosterone were both undetectable in six of the patients. 11-deoxycortisol, the precursor hormone accumulated right above the inhibition of 11β-hydroxylase (range: 72.4–564; reference ≤4.3 nmol/l) and 17-OHP (range 8.7–11; reference <4 nmol/l) along the glucocorticoid pathway of steroidogenesis were found elevated in four patients.

Conclusion: These alarming consequences have heightened awareness among healthcare professionals and the broader community, underscoring the urgent need to identify, intercept, and prevent the proliferation of this harmful substance. Safeguarding our younger generations from the devastating effects of such abuse is a collective responsibility that demands concerted efforts in education, intervention and policy development.