J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Case Report

Volume 10, Number 6, December 2020, pages 190-194

A Case of Etomidate Use in Management of Adrenocortical Carcinoma With Hypercortisolemia

Figure 1. Computed tomography of the abdomen revealed a large multi-loculated, septate, cystic left adrenal mass measuring 15 × 10 × 8 cm.

**Table 1.** Blood Results on Presentation to Emergency Department
Blood investigation	Results	Reference range
ALT: alanine transaminase; ACTH: adrenocorticotropic hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; DHEAS: dehydroepiandrosterone sulfate; TSH: thyroid-stimulating hormone.
Sodium (mmol/L)	138	133 - 146
Potassium (mmol/L)	2.8	3.5 - 5.3
Urea (mmol/L)	5.2	2.5 - 7.8
Creatinine (µmol/L)	61	50 - 98
Adjusted Calcium (mmol/L)	2.33	2.20 - 2.60
ALT (IU/l)	37	< 56
Hemoglobin (g/L)	115	115 - 165
White cell count (× 10⁹/L)	8.6	4.0 - 11.0
Platelets (× 10⁹/L)	149	150 - 450
ACTH (ng/L)	< 0.3	0 - 50 ng/L
LH (IU/L)	< 0.1	Follicular 1.8 - 11.7/peak 7.6 - 89.0/luteal 0.6 - 14.0
FSH (IU/L)	0.1	Follicular 3.1 - 8.0/peak 2.6 - 12.6/luteal 1.4 - 5.4
Estradiol (pmol/L)	37	Proliferative 220 - 918/luteal 275 - 1,650/menopausal < 40
DHEAS (µmol/L)	36.20	4.02 - 11.00
Androstenedione (nmol/L)	24.10	0.9 - 7.5
Testosterone (nmol/L)	2.51	0.00 - 1.90
Prolactin (mIU/L)	408	63 - 561
TSH (mIU/L)	0.699	0.350 - 4.94
Free thyroxine (pmol/L)	21.2	9.0 - 19.0

Table 1. Blood Results on Presentation to Emergency Department

Blood investigation

Results

Reference range

ALT: alanine transaminase; ACTH: adrenocorticotropic hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; DHEAS: dehydroepiandrosterone sulfate; TSH: thyroid-stimulating hormone.

Sodium (mmol/L)

138

133 - 146

Potassium (mmol/L)

2.8

3.5 - 5.3

Urea (mmol/L)

5.2

2.5 - 7.8

Creatinine (µmol/L)

50 - 98

Adjusted Calcium (mmol/L)

2.33

2.20 - 2.60

ALT (IU/l)

< 56

Hemoglobin (g/L)

115

115 - 165

White cell count (× 10⁹/L)

8.6

4.0 - 11.0

Platelets (× 10⁹/L)

149

150 - 450

ACTH (ng/L)

< 0.3

0 - 50 ng/L

LH (IU/L)

< 0.1

Follicular 1.8 - 11.7/peak 7.6 - 89.0/luteal 0.6 - 14.0

FSH (IU/L)

0.1

Follicular 3.1 - 8.0/peak 2.6 - 12.6/luteal 1.4 - 5.4

Estradiol (pmol/L)

Proliferative 220 - 918/luteal 275 - 1,650/menopausal < 40

DHEAS (µmol/L)

36.20

4.02 - 11.00

Androstenedione (nmol/L)

24.10

0.9 - 7.5

Testosterone (nmol/L)

2.51

0.00 - 1.90

Prolactin (mIU/L)

408

63 - 561

TSH (mIU/L)

0.699

0.350 - 4.94

Free thyroxine (pmol/L)

21.2

9.0 - 19.0

**Table 2.** Dose of Etomidate and Cortisol During the ICU Admission
Day of ICU admission	Cortisol level (nmol/L)	Dose of etomidate (µg/kg/h)
ICU: intensive care unit.
1	1,041	42.86
2	287	42.86
3	107	28.57
4	227	14.28
5	210	0
6	569	0

Table 2. Dose of Etomidate and Cortisol During the ICU Admission

Day of ICU admission

Cortisol level (nmol/L)

Dose of etomidate (µg/kg/h)

ICU: intensive care unit.

1,041

42.86

287

42.86

107

28.57

227

14.28

210

569

**Table 3.** Blood Results From Day 3 of ICU Admission
Blood investigations	Results	Normal values
ICU: intensive care unit; LDH: lactate dehydrogenase.
Hemoglobin (g/L)	85 (126 on admission)	115 - 165
Reticulocytes count (%)	10.240	0.200 - 2.000
LDH (IU/L)	1,267	125 - 264
Haptoglobin (g/L)	1.80	0.30 - 2.00 g/L
Total bilirubin (µmol/L)	11	5 - 26 µmol/L
Direct Coombs	Negative	-
Iron (µmol/L)	14.0	9.0 - 30.0
Transferrin (g/L)	1.48	1.80 - 3.82
B12 (pg/mL)	314	187 - 883
Folate (ng/mL)	2.8	3.1 - 20.5
Blood film	Leukocyte morphology no abnormality detected, rouleaux present, anisochromic red blood cells	-

Table 3. Blood Results From Day 3 of ICU Admission

Blood investigations

Results

Normal values

ICU: intensive care unit; LDH: lactate dehydrogenase.

Hemoglobin (g/L)

85 (126 on admission)

115 - 165

Reticulocytes count (%)

10.240

0.200 - 2.000

LDH (IU/L)

1,267

125 - 264

Haptoglobin (g/L)

1.80

0.30 - 2.00 g/L

Total bilirubin (µmol/L)

5 - 26 µmol/L

Direct Coombs

Negative

Iron (µmol/L)

14.0

9.0 - 30.0

Transferrin (g/L)

1.48

1.80 - 3.82

B12 (pg/mL)

314

187 - 883

Folate (ng/mL)

2.8

3.1 - 20.5

Blood film

Leukocyte morphology no abnormality detected, rouleaux present, anisochromic red blood cells