Drug-induced endocrine disorders in the intensive care unit

Abstract

The neuroendocrine response to critical illness is key to the maintenance of homeostasis. Many of the drugs administered routinely in the intensive care unit significantly impact the neuroendocrine system. These agents can disrupt the hypothalamic-pituitary-adrenal axis, cause thyroid abnormalities, and result in dysglycemia. Herein, we review major drug-induced endocrine disorders and highlight some of the controversies that remain in this area. We also discuss some of the more rare drug-induced syndromes that have been described in the intensive care unit. Drugs that may result in an intensive care unit admission secondary to an endocrine-related adverse event are also included. Unfortunately, very few studies have systematically addressed drug-induced endocrine disorders in the critically ill. Timely identification and appropriate management of drug-induced endocrine adverse events may potentially improve outcomes in the critically ill. However, more research is needed to fully understand the impact of medications on endocrine function in the intensive care unit.

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

“…97 The mechanisms of action by which glucocorticoids result in SH include increase in gluconeogenesis, increase in insulin resistance, and impaired insulin secretion by the pancreas. 98 Thiazide diuretics are associated with the occurrence of SH, largely due to a decrease in whole body potassium, with corresponding reduction in insulin secretion. 99 Stress hyperglycemia is observed with the use of beta blocking agents, due to reduction in insulin secretion from pancreatic β cells.…”

“…99 Chronic administration of pentamidine can result in SH, due to impaired insulin release and pancreatic β-cell destruction. 98 Calcineurin inhibitors, such as tacrolimus and cyclosporine, can result in SH and post-transplant diabetes, due to decreases in insulin biosynthesis and release. 98 Newer atypical antipsychotics (clozapine and olanzapine) are associated with SH, diabetes mellitus, and even life-threatening diabetic ketoacidosis.…”

“…98 Calcineurin inhibitors, such as tacrolimus and cyclosporine, can result in SH and post-transplant diabetes, due to decreases in insulin biosynthesis and release. 98 Newer atypical antipsychotics (clozapine and olanzapine) are associated with SH, diabetes mellitus, and even life-threatening diabetic ketoacidosis. The mechanisms are likely due to development of insulin resistance and inhibition of insulin secretion.…”

“…The mechanisms are likely due to development of insulin resistance and inhibition of insulin secretion. 98,99 Other causes of SH in critical illness include administration of antibiotic and antifungal medications in large volumes of dextrose-containing solutions.…”

Encephalopathy Associated with Psychotropic Drug Therapy

“…Antipsychotics, in particular atypical antipsychotics such as clozapine and olanzapine, are reported to be associated with an increased risk of obesity, diabetes, and metabolic syndrome (Scheen & De Hert, 2007;Smith et al, 2008) and in the worse case it can result in fatal hyperglycemic encephalopathy (Koller & Doraiswamy, 2002;Wehring et al, 2003). Lithium, a widely used mood stabilizer, increases the risk of hypothyroidism, which can range from subclinical to life-threatening myxedema coma (Bhuvaneswar et al, 2009;Thomas et al, 2010). A case of Hashimoto's encephalopathy possibly induced by lithium was also reported (Nagamine et al, 2008).…”