Authors (including presenting author) :
Cheung YT(1)(2), Lau CY(3), Tseung JSB(1)(2), Yu KYC(1)(2), Chen SPL(3), Chong YK(1)(2)
Affiliation :
(1) Department of Pathology, Princess Margaret Hospital
(2) Hong Kong Poison Control Centre
(3) Department of Pathology, Queen Elizabeth Hospital
Introduction :
Etomidate, an induction agent used in anaesthesia, is known to possess inhibitory activity on steroid 11β-hydroxylase at subanaesthetic concentrations. An emerging trend of abuse of etomidate as well as its analogue isopropoxate has recently been observed. Their effects on adrenal steroidogenesis as drugs of abuse remain to be elucidated.
Objectives :
In the present study, we analysed the steroid excretion patterns of etomidate and isopropoxate users for evidence of disrupted steroidogenesis.
Methodology :
Urine steroid profiling was performed on urine specimens tested positive for etomidate, isopropoxate and/or their metabolites by liquid chromatography-tandem mass spectrometry. Results were compared with routine clinical specimens with normal adult (≥ 18 years of age) urine steroid profiles, analysed between 1st January 2022 and 24th June 2024. Steroid metabolites were measured by gas chromatography-mass spectrometry-based methods. Additional clinical and biochemical data were retrieved from the electronic patient records for review.
Result & Outcome :
Ten male and ten female adult users, aged 18 to 54 years, were included in this study. Their steroid excretion patterns were compared against 377 normal profiles. Hypokalaemia and concomitant drugs of abuse were present in the majority of cases. Psychiatric symptoms were noted in eight out of 20 cases. Multiple metabolites, including tetrahydro-11-deoxycortisol, tetrahydro-deoxycorticosterone and multiple adrenal androgen metabolites, were elevated in etomidate and isopropoxate abusers. The urine steroid pattern is compatible with 11β-hydroxylase inhibition.
11β-hydroxylase inhibition was demonstrated in recreational users of etomidate and isopropoxate. Such activity contributes to the clinical features of hypokalaemia, and hyperandrogenism in female patients. Misuse of the compounds could be a harbinger of an increasing prevalence of acquired 11β-hydroxylase deficiency.
