Drug-induced endocrine disorders in the intensive care unit.
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.
Thomas
Zachariah
Z
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy-Rutgers, State University of New Jersey, New Brunswick, NJ, USA. zthomas@rci.rutgers.edu
Bandali
Farooq
F
McCowen
Karen
K
Malhotra
Atul
A
D000638:Amiodarone / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D000935:Antifungal Agents / Q000009:adverse effects; D018692:Antimanic Agents / Q000009:adverse effects; D003422:Critical Care / Q000379:methods; D065607:Cytochrome P-450 Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects; D004298:Dopamine / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000503:physiopathology; D004700:Endocrine System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D005045:Etomidate / Q000009:adverse effects; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007328:Insulin / Q000009:adverse effects; D007362:Intensive Care Units; D008094:Lithium / Q000009:adverse effects; D010182:Pancreatic Diseases / Q000139:chemically induced; D010913:Pituitary-Adrenal System / Q000187:drug effects; D013959:Thyroid Diseases / Q000139:chemically induced; D014481:United States
D000889:Anti-Arrhythmia Agents; D000935:Antifungal Agents; D018692:Antimanic Agents; D065607:Cytochrome P-450 Enzyme Inhibitors; D005938:Glucocorticoids; D006993:Hypnotics and Sedatives; D007328:Insulin; D003577:Cytochrome P-450 Enzyme System; D008094:Lithium; D000638:Amiodarone; D004298:Dopamine; D005045:Etomidate