Drug-induced endocrine and metabolic disorders.
Complex interactions exist amongst the various components of the neuroendocrine system in order to maintain homeostasis, energy balance and reproductive function. These components include the hypothalamus-pituitary- adrenal and -gonadal axes, the renin-angiotensin-aldosterone system, the sympathetic nervous system and the pancreatic islets. These hormones, peptides and neurotransmitters act in concert to regulate the functions of many organs, notably the liver, muscles, kidneys, thyroid, bone, adrenal glands, adipocytes, vasculature, intestinal tract and gonads, through many intermediary pathways. Endocrine and metabolic disorders can arise from imbalance amongst numerous hormonal factors. These disturbances may be due to endogenous processes, such as increased secretion of hormones from a tumour, as well as exogenous drug administration. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the hormonal axis, effects on hormonal transport, binding, and signalling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can affect the evaluation of endocrine parameters by causing interference with diagnostic tests. Common drug-induced endocrine and metabolic disorders include disorders of carbohydrate metabolism, electrolyte and calcium abnormalities, as well as drug-induced thyroid and gonadal disorders. An understanding of the proposed mechanisms of these drug effects and their evaluation and differential diagnosis may allow for more critical interpretation of the clinical observations associated with such disorders, better prediction of drug-induced adverse effects and better choices of and rationales for treatment.
Ma
Ronald C W
RC
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China. rcwma@cuhk.edu.hk
Kong
Alice P S
AP
Chan
Norman
N
Tong
Peter C Y
PC
Chan
Juliana C N
JC
D002128:Calcium Metabolism Disorders / Q000139:chemically induced; D064420:Drug-Related Side Effects and Adverse Reactions; D004700:Endocrine System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D006058:Gonadal Disorders / Q000139:chemically induced; D006801:Humans; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000175:diagnosis; D013959:Thyroid Diseases / Q000139:chemically induced; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced