Endocrine 1 Final: Nemechek Drug Induced Endocrine Disorders

___ is one of the biggest drivers of drug-induced thyroid dysfunction

Iodine

Drug-Induced Hyperthyroidism

1. ____

2. Chinese Herbal Medications (seaweed-derived)

3. interferon-alpha (less common)

Amiodarone

Amiodarone can cause hyperthyroidism due to its very high ____ content (75mg per 200mg tablet; normal intake is 150 micrograms)

iodine

Drug-Induced Hypothyroidism

1. ____

2. ____

3. interferon-alpha (more common)

Amiodarone, Lithium

Amiodarone can cause hypothyroidism:

-destructive ____

-inhibition of 5'-monodeiodinase leading to decreased ___

-chronic elevation of iodine, which leads to ___ inhibition of thyroid hormone synthesis

thyroiditis, T3, negative

Lithium causes hypothyroidism via inhibiting thyroid ____

synthesis

Lithium

-____ only occurs in 1-3% of patients on lithium (only at REALLY high doses)

hypothyroidism

Drug-Induced Hyperglycemia is due to:

-Decreased insulin ___ (acute)

-Impact on liver glucose ___ (acute)

-Increased peripheral tissue insulin ___ (chronic)

-Increased ___-__ responses (chronic

secretion, metabolism, resistance, counter-regulatory

What is the most common agent that causes Drug-Induced Hyperglycemia (works by all 4 mechanisms)?

Glucocorticoids

How do you manage Drug-Induced Hyperglycemia from glucocorticoids (ie steroid induced hyperglycemia)?

-once daily ___ insulin

NPH

How much NPH insulin to give for steroid-induced hyperglycemia?

-If patient is receiving ≥ 40 mg/day of prednisone or equivalent → start ___ units/kg

0.4

Only give NPH insulin if steroid use causes a ___ surge (ie don't just give it to all patients receiving steroids)

glucose

Drug-Induced Hypoglycemia is due to:

-Increased insulin ____

-Decreased action of ___-___ hormones

secretion, counter-regulatory

Drug-Induced Hypoglycemia-Increased Insulin Secretion

-___

-___

-___

sulfonylureas, pentamidine, quinine

Drug-Induced Hypoglycemia-Decreased action of counter-regulatory hormones

-___

-___

octreotide, alcohol

Do beta blockers cause hyperglycemia?

no

Beta blockers mask the symptoms of ___

hypoglycemia