Thyroid, Adrenal, And Miscellaneous Endocrine Drugs

Heat intolerance, weight loss, tachycardia, tremor and anxiety are cardinal features of hyperthyroidism. Propylthiouracil is effective at reducing the excessive thyroxine level.

Chronic administration of glucocorticoids such as prednisone will lead to feedback inhibition of pituitary ACTH release, and atrophy of the adrenal cortex. When prednisone is abruptly stopped, the adrenals will not be able to meet the body's demand for cortisol during severe stress and adrenal crisis may occur.

Testosterone cypionate in oil is a depot injection and is recommended to be given every 2–4 weeks. Topical formulations are applied daily, and oral formulations are taken every 12–24 hours.

The listed symptoms are all associated with Cushing’s disease (adrenal hyperactivity). Addison’s disease represents the opposite to Cushing’s disease (hypoadrenal state), whereas the other three options refer to diseases of the thyroid.

Bile acid sequestrants reduce levothyroxine absorption and must be separated from levothyroxine administration by at least 4 hours. Levothyroxine should be administered before a meal on an empty stomach in order to maximize absorption.

Glucocorticoids have catabolic effects on a number of tissues, including muscle, fat, skin, and bone. Chronic administration leads to osteopenia and osteoporosis.

Ketoconazole is effective for treatment of Cushing’s disease at high doses. The other antifungals listed have not been shown to be effective.

esmopressin (DDAVP) is a synthetic analog of vasopressin, or antidiuretic hormone. Thus it decreases urine production by increasing water resorption.

Corticosteroids are well known to cause hyperglycemia and should be used in caution in patients with diabetes mellitus.

Levothyroxine decreases bone mineral density and when given in supratherapeutic doses may cause osteoporosis. For this reason, the lowest possible replacement dose should be administered.

Hydrocortisone is the drug of choice for adrenal crisis since it possesses both mineralocorticoid and glucocorticoid properties. Although cosyntropin increases cortisol release, patients with adrenal crisis may not have enough adrenal reserve to meet their increased demand.

Corticosteroids such as dexamethasone (Decadron) are known to increase the risk of peptic ulcers when used in combination with NSAIDs.

Cosyntropin (synthetic adrenocorticotropic hormone) should stimulate release of cortisol when administered. Adrenal response to cosyntropin administration is a diagnostic indicator of adrenal insufficiency.

Glucocorticoids have potent effects on glucose and carbohydrate metabolism. They promote glycogen breakdown, rather than inhibit it.

Desmopressin, an antidiuretic hormone analog, may be used to control nocturnal enuresis

Desmopressin increases clotting factors and circulating platelets and may be used to control bleeding in surgical or other conditions.

Desmopressin therapy is associated with hyponatremia, which may be severe and cause neurologic abnormalities.

Thyroid hormones enhance oxygen consumption and increase the oxygen demand. Mrs. Ricardo has a past medical history of coronary artery disease (CAD), and is elderly. Thyroid supplementation would actually lower her cholesterol in the long run, but may precipitate angina acutely.

The best treatment plan for S. M.'s corticosteroid therapy in the long term is to change his corticosteroid to the equivalent dose of prednisone po and gradually taper it over the course of 2 weeks until discontinued. This is because S. M. is experiencing significant heartburn, which is a common side effect of corticosteroid therapy. Tapering the dose of prednisone gradually helps to prevent withdrawal symptoms and allows the body to adjust to lower levels of the medication. This approach ensures that S. M. can safely discontinue the corticosteroid without experiencing any adverse effects.

Anabolic steroids may be abused by those who are seeking enhanced muscular development and endurance, such as athletes. For this reason, all of these agents are subject to the Controlled Substances Act.

Ketoconazole, aminoglutethimide, and mitotane are all used to treat Cushing's disease. Ketoconazole is most commonly known as an antifungal agent, but it inhibits cortisol synthesis at high doses (800-1200 mg daily).

Captopril increases insulin sensitivity and would not be expected to contribute to increased blood glucose. This patient's blood glucose began rising shortly after admission. His IV fluids contain glucose, epinephrine increases blood glucose by increasing glycogen breakdown, methylprednisolone (Solu-Medrol) promotes glycogenolysis, and anaphylaxis would be expected to increase stress response leading to increased epinephrine release and increased blood glucose.
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Liothyronine (Cytomel) is T3, a potent thyroid hormone. In states of hypothyroidism, metabolism is decreased. However, if thyroid hormone is supplemented, blood clotting factors will be metabolized more quickly, leading to decreased warfarin requirements.

The patient has a history of diabetes and will be given prednisone (Deltasone), which would be expected to increase blood glucose. When diabetes is poorly controlled, infections are more likely to occur. For this reason, he should monitor more closely for wounds that may become infected. He will not be taking prednisone long enough to develop adrenal insufficiency, so there is no need for him to wear identification for steroid therapy.

Iodine preparations work more rapidly than propylthiouracil or methimazole in thyroid storm and are preferred for acute control of this condition.

Cosyntropin (Cortrosyn) is a synthetic analog of ACTH that is used to diagnose adrenal insufficiency. It works by stimulating the adrenal cortex to secrete cortisol. If cosyntropin administration does not result in an appropriate increase in cortisol release, adrenal insufficiency is present.

Gynecomastia and acne are both adverse effects commonly associated with androgens and anabolic steroids.

Discontinuation or decrease of the prednisone V. R. takes at home may precipitate withdrawal symptoms caused by HPA axis suppression. Increasing the dose to four times the home dose or converting to an IV formulation is not necessary according to the clinical situation of V. R.

Metyrapone (Metopirone) inhibits 11-hydroxylase activity, and thus decreases cortisol synthesis.

Vasopressin has antidiuretic and vasoconstrictive properties that may enhance the effects of vasopressors and decrease the required doses of vasopressors in sepsis.

Testosterone transdermal systems (Androderm, Testoderm) are both applied once daily for 24 hours. Longer acting androgens are available, such as nandrolone decanoate (Deca-Durabolin), for once weekly administration.

Adrenocorticotropic hormone, or ACTH, is released by the pituitary and acts on the adrenal glands to increase cortisol release. Corticotropin-releasing hormone is released by the hypothalamus and acts on the pituitary to stimulate ACTH release.

Ketoconazole requires the presence of stomach acid in order to be absorbed. Any drug that decreases gastric acidity will decrease the extent of ketoconazole absorption. Food increases ketoconazole absorption since food stimulates release of gastric acid.

Fludrocortisone is almost purely mineralocorticoid and is used for increasing blood pressure rather than for anti-inflammatory effects.

Stanozolol (Winstrol) is an androgen that would be expected to promote growth and development of male sex organs. However, chronic administration leads to feedback inhibition of testosterone secretion which leads to testicular atrophy.

Mitotane is cytotoxic to adrenal cells and thus reduces cortisol synthesis and release. ACTH increases cortisol release. Close monitoring of cortisol levels is important when this drug is used.

A digital rectal exam should be used to monitor the patient for adverse effects from methyltestosterone. Methyltestosterone is a medication used to treat AIDS-related wasting disease, and it can have side effects on the prostate gland. By performing a digital rectal exam, the healthcare provider can assess the size, shape, and texture of the prostate gland and check for any abnormalities or signs of prostate-related adverse effects. This monitoring is important to ensure the patient's safety and to detect any potential complications early on.

Numerous drugs are known to decrease thyroid hormone absorption, including antacids that contain divalent and trivalent cations, calcium salts, magnesium, sucralfate, and bile-acid sequestrants. Estrogens and enzyme-inducing drugs may decrease circulating thyroid hormone levels and necessitate a dose increase of thyroxine.

Lithium and amiodarone have both been associated with hypothyroidism. Amiodarone contains iodine, and may cause hypo- or hyperthyroidism.

At this point, V. R. has become critically ill and is also not to take anything by mouth. She will require an IV formulation of corticosteroids and will require a higher dose than her usual home dose because of the increased physiologic stress her body is under and her presumed lack of ability to mount additional adrenal response because of her long-term corticosteroid use.