Ectopic ACTH syndrome (EAS) remains one of the most demanding diagnostic and therapeutic challenges for endocrinologists. Thymic neuroendocrine tumors account for 5%-10% of all EAS cases. We report a unique case of a 31-year-old woman with severe EAS caused by primary metastatic combined large-cell neuroendocrine carcinoma and atypical carcinoid of the thymus. The patient presented with severe hypercortisolemia, which was successfully controlled with continuous etomidate infusion. Complex imaging initially failed to detect thymic lesion; however, it revealed a large, inhomogeneous, metabolically active left adrenal mass infiltrating the diaphragm, suspected of primary disease origin. The patient underwent unilateral adrenalectomy, which resulted in hypercortisolemia resolve. The pathology report showed an adenoma with adrenal infarction and necrosis. The thymic tumor was eventually revealed a few weeks later on follow-up imaging studies. Due to local invasion and rapid progression, only partial resection of the thymic tumor was possible, and the patient was started on radio- and chemotherapy.

Hypokalemia is a common clinical condition that can lead to muscle weakness, difficulty breathing, malignant arrhythmias, and even death. This report describes two cases of severe hypokalemia resulting from the use of electronic cigarettes containing etomidate, both accompanied by varying degrees of adrenal hyperplasia. In both cases, the patients were admitted to the hospital with lower limb weakness and difficulty walking. Relevant examinations revealed low blood potassium, low cortisol, high adrenocorticotropic hormone, low renin, and low aldosterone levels in the patients, with Case 2 also having significant hypertension. In both cases, adrenal CT scans showed thickening of the adrenal glands. After the delivery of potassium supplementation in both cases, blood potassium levels gradually returned to normal and muscle strength gradually improved. The case reports are followed by a review of the literature on etomidate and its related mechanisms of action with discussion of its association with hypokalemia.

Etomidate is a nonbarbiturate sedative derived from imidazole. Prolonged and excessive use of etomidate can lead to the suppression of adrenocortical function, myoclonus, and even death. This report describes a rare case of a 47-year-old man who died from acute intoxication after oral ingestion of liquid containing etomidate. The cause of death was conclusively attributed to etomidate based on a comprehensive investigation, including autopsy, histopathological examination, toxicological analysis, and biochemical analysis. This is the first reported case of a fatality solely resulting from the oral ingestion of etomidate, which can provide valuable insights for future forensic investigations involving etomidate poisoning. Therefore, it is imperative to share this case with the scientific community.

暂无摘要。

某日04：00时许，公安机关接报警称某酒店1名男性住客黄某不省人事，经“120”到场抢救无效死亡。经调查，死者黄某死亡前与女友一起吸食“烟粉”后入睡，其女友醒来后发现黄某已无反应。据调查，黄某生前曾多次吸食依托咪酯。为查明黄某的死亡原因，对其进行尸体检验。.

Etomidate is an ultra-short-acting anesthetic agent derived from imidazole that can only be administered intravenously. Etomidate has excellent hemodynamic properties in inducing anesthesia, making it an ideal choice for patients with shock, hypovolemia, or significant cardiovascular disease, with minimal reduction in blood pressure. We report a case of a female patient who was given accidental etomidate intrathecally instead of ropivacaine because of its similar appearance, which led to a slight decrease in blood pressure and no change in the pulse rate. The patient had stable vital signs and no neurological complications.

暂无摘要。

Metomidate and etomidate belong to the non-barbiturate imidazole family of sedative-hypnotics and elicit little analgesic action when used alone. Metomidate, in particular, has little analgesic activity in humans and is, therefore, used for veterinary purposes. In 2019, a Korean woman in her twenties was found unconscious in a motel bath and eventually died. Etomidate, alprazolam, escitalopram, and metomidate were detected in the postmortem specimens. To our knowledge, this is the first case of human metomidate abuse reported in the Republic of Korea. In this research, a simple and reliable method was developed for the analysis of metomidate and etomidate in human blood samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Blood samples were deproteinized with acetonitrile, filtered, and analyzed by LC-MS/MS. Linear calibration curves were obtained with six concentrations ranging from 1 to 50 ng/ml for metomidate and 10 to 500 ng/ml for etomidate. The method was validated by assessing the selectivity, linearity, limit of detection (LOD), limit of quantitation (LOQ), intra- and inter-day precision and accuracy, matrix effect, and stability and successfully applied to the analysis of metomidate and etomidate in human blood samples. In a postmortem case, the concentrations of metomidate and etomidate were found to be 8 and 110 ng/ml in femoral blood and 6 and 210 ng/ml in cardiac blood, respectively.

Suicide is still an important issue in developed countries. The problem affects all age groups and both sexes, although usually more commonly middle-aged men. Attempted suicides committed by taking drugs ended in death are rare (regardless of gender, age, social group) except among health professionals who have easy access to medications and the knowledge of their use. This paper describes a case of a paramedic\'s suicide and discusses the literature on the issue of suicides in terms of statistics. The paramedic, who is the subject of this case story suffered from depression and alcohol dependence and committed suicide at work using the medicines available in the Medical Air Rescue service: morphine, diazepam, etomidate and rocuronium. Toxicological studies revealed that the man had also been taking sertraline, a commonly used antidepressant. The reasons for suicide among healthcare professionals are the same as for the general population; however, given the extremely high work-related stress and easy availability of drugs that can be effectively used to commit suicide, a special approach to the issue is necessary.

UNASSIGNED: To report a case of etomidate induced seizure in a patient that received 0.15 mg/kg of etomidate for a procedural sedation which resolved without intervention.
UNASSIGNED: A 68-year-old woman presented to the emergency department with a dislocated shoulder. Etomidate was given to the patient for procedural sedation to allow the physician to reduce the shoulder dislocation. Upon administration of the medication, the patient began seizing; this lasted for about 2 minutes. No medications were needed for cessation of the seizure.
UNASSIGNED: A causality assessment determined that the adverse effect of the epileptogenic action in etomidate was possible. Limited data is available in regard to the incidence rate of this adverse effect.