SEVERE REFRACTORY HYPERCORTISOLISM FROM ATYPICAL THYMIC CARCINOID TUMOR MANAGED WITH ETOMIDATE INFUSION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Severe Cushing's syndrome is associated with life threatening metabolic, infectious and neuropsychiatric complications. We present a case of severe from atypical thymic carcinoid tumor managed low dose etomidate infusion. CASE PRESENTATION: 27 year old woman history polycystic ovarian insulin resistance, who was previously diagnosed ACTH producing Atypical presented for evaluation recurrent hypokalemia. 9 months prior, she had weight gain, hirsutism diagnostic workup at that time revealed 3.5cm encircling the left common carotid vertebral artery in anterior mediastinum, biopsy proven paraspinal metastases endobronchial process right lung. She initiated on ketoconazole time, while closely monitoring cortisol levels. While neoadjuvant chemotherapy followed by surgery recommended, patient reluctant sought naturopathic methods. Ketoconazole dosage uptitrated given increasing developed transaminitis forcing stoppage ketoconazole. Mifepristone (korlym) along spironolactone KCl were started. However levels, hypokalemia despite oral therapy, other treatment options sought. Repeat CTA chest showed unchanged soft tissue density circumscribing great vessels no stenosis or mass effect measuring up to 3.4 x 3.3 cm, extending base thyroid lobe aortic arch. Etomidate bolus infusion started manage refractory hypercortisolism, titrated according goal serum levels 15-25 mcg/dL. Options bilateral adrenalectomy requiring lifelong steroid supplementation, surgical debulking significant risk location, mitotane radiotherapy offered. currently receiving - carboplatin/etoposide her have been stable. DISCUSSION: inhibits 11 beta-hydroxylase, cytochrome P-450 dependent adrenal enzyme involved steroidogenesis, thereby lowering In our patient, 0.06 mg/kg once, rate 0.02 mg/kg/hr successfully inhibited production as measured resultant improvement Literature scant cases hypercortisolism Low effective recommended achieve rapid control serving bridge long-term definitive management. CONCLUSIONS: can be used complications REFERENCE #1: Lebek-Szatanska A, Nowak KM, Zgliczynski W, Baum E, Zylka Papierska L. Low-dose management hypercortisolaemia different clinical scenarios: series review literature. Ther Adv Endocrinol Metab. 2019 Feb 8;10:2042018819825541. doi: 10.1177/2042018819825541. PMID: 30800267; PMCID: PMC6378481 #2: Reza-Albarrán AA, Andino Ríos GG, Gómez Herrera LG. neuroendocrine carcinoma. Clin Rep. 2018 Mar 12;6(5):851-854. 10.1002/ccr3.1478. 29744071; PMC5930188. DISCLOSURES: No relevant relationships Douglas Bosin, source=Web Response Akshay Muralidhar, Hursh Sarma, Cindrel Tharumia Jagadeesan,