Vaped etomidate linked to acquired adrenal hyperplasia in Hong Kong case series

A retrospective review of 76 cases from the Hong Kong Poison Control Centre database found that etomidate and its analogues, abused via e-cigarettes since 2023, were associated with an acquired form of 11β-hydroxylase deficiency adrenal hyperplasia. The study reported a pentad of mineralocorticoid excess, apparent glucocorticoid deficiency, virilisation, ACTH excess, and adrenal hyperplasia, with three associated deaths; the authors noted partial reversibility of hypokalaemia, low cortisol, and elevated ACTH in a small subset of cases.

Most relevant for: Teenage and young adult patients presenting with hypokalaemia, virilisation, menstrual disturbances, or hyperpigmentation suggestive of congenital adrenal hyperplasia, particularly those with a history of vaping or substance abuse.

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