Acquired 11β-Hydroxylase Deficiency by Inhaled Etomidate and Its Analogues: A Mimic of Congenital Adrenal Hyperplasia

A 35-year-old female exhibited symptoms similar to 11β-hydroxylase deficiency, such as hyperandrogenism and male-pattern alopecia, linked to inhaling e-cigarette oil containing etomidate and its analogues. Despite negative genetic tests for congenital causes, her condition was attributed to these substances blocking adrenal 11β-hydroxylation. This case is the first to report adrenocortical suppression from chronic e-cigarette use of etomidate analogues, highlighting the need for physician awareness of potential drug abuse in e-cigarette users. Treatment involved hydrocortisone and blood pressure management, but the patient continued e-cigarette use. The study calls for more clinical cases to validate these findings.