BACKGROUND: Psychosis secondary to paediatric Cushing's disease (CD) is extremely rare and presents a significant management challenge. METHOD: 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. CONCLUSION: This case illustrates the safe and effective use of a low-dose etomidate infusion in an unusual case of paediatric CD.
BACKGROUND:Psychosis secondary to paediatric Cushing's disease (CD) is extremely rare and presents a significant management challenge. METHOD: We report a 14.7-year-old CDpatient 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. CONCLUSION: This case illustrates the safe and effective use of a low-dose etomidate infusion in an unusual case of paediatric CD.
Authors: Hanan D Trotman; Carrie W Holtzman; Arthur T Ryan; Daniel I Shapiro; Allison N MacDonald; Sandra M Goulding; Joy L Brasfield; Elaine F Walker Journal: Horm Behav Date: 2013-07 Impact factor: 3.587
Authors: C W Holtzman; H D Trotman; S M Goulding; A T Ryan; A N Macdonald; D I Shapiro; J L Brasfield; E F Walker Journal: Neuroscience Date: 2013-01-05 Impact factor: 3.590
Authors: Lynnette K Nieman; Beverly M K Biller; James W Findling; M Hassan Murad; John Newell-Price; Martin O Savage; Antoine Tabarin Journal: J Clin Endocrinol Metab Date: 2015-07-29 Impact factor: 5.958
Authors: Galina Yordanova; Lee Martin; Farhad Afshar; Ian Sabin; Ghassan Alusi; Nicholas P Plowman; Fiona Riddoch; Jane Evanson; Matthew Matson; Ashley B Grossman; Scott A Akker; John P Monson; William M Drake; Martin O Savage; Helen L Storr Journal: Pituitary Date: 2016-12 Impact factor: 4.107
Authors: Rosario Ferrigno; Valeria Hasenmajer; Silvana Caiulo; Marianna Minnetti; Paola Mazzotta; Helen L Storr; Andrea M Isidori; Ashley B Grossman; Maria Cristina De Martino; Martin O Savage Journal: Rev Endocr Metab Disord Date: 2021-01-30 Impact factor: 6.514