scholarly journals Glucocorticoid therapy and adrenal suppression

2017 ◽  
Vol 70 (11-12) ◽  
pp. 465-471 ◽  
Author(s):  
Damir Benc ◽  
Tijana Icin ◽  
Sladjana Pejakovic ◽  
Ivana Bajkin ◽  
Jovana Prodanovic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Adrenal Insufficiency ◽  
Chronic Administration ◽  
Therapeutic Benefit ◽  
Glucocorticoid Therapy ◽  
Adrenal Suppression ◽  
Wide Range ◽  
Therapy Reduction ◽  
Synthetic Glucocorticoids

Introduction. Adrenal insufficiency results from the inadequate adrenocortical conjunction. Adrenal insufficiency can be primary, secondary and tertiary one. The most common cause of adrenal suppression is the effect of exogenous therapy with glucocorticoids. Glucocorticoids. Corticosteroids are used in treatment of endocrine and non-endocrine diseases. They are applied as a substitution therapy in the patients with primary and secondary adrenal insufficiency. Due to their immunosuppressive and anti-inflammatory characteristics, they are used to treat a wide range of diseases. They are usually divided according to the length and size of the effect i.e. how they are applied. Adrenal Insufficiency. Glucocorticoid therapy may lead to a number of adverse effects such as a disorder in glucose metabolism, osteoporosis or frequent infections. Adrenal suppression is the most common complication resulting from corticosteroid application. The function of the hypothalamus-pituitary-adrenal axis may be inhibited for months after the treatment cessation. There are several predictors of potential glucocorticoid-induced adrenal suppression. Diagnosing Adrenal Insufficiency. The most frequent symptoms and signs of adrenal insufficiency are fatigue, nausea and vomiting, hyponatremia, hyperpigmentation or hypotension. Algorithm for the diagnosis of adrenal insufficiency must be followed in clinical practice. Reduction in Glucocorticoid Therapy. Reduction or complete cessation of the therapy is indicated when the maximum therapeutic benefit has been achieved or when considerable side effects, such as diabetes mellitus, severe hypertension, osteoporosis i.e. adrenal insufficiency, develop. Conclusion. Numerous synthetic glucocorticoids have been developed to be used in everyday clinical practice and they can be administered systemically or locally. A lot of side effects are associated with chronic administration of glucocorticoids. In order to avoid complications, it is recommended to administer intermediate-acting glucocorticoids every second day. In addition, the patients must be monitored carefully and glucocorticoid therapy should be discontinued gradually to prevent adrenal insufficiency or reactivation of the disease under therapy.

Glucocorticoid-induced osteoporosis

2011 ◽  
pp. 754-759
Author(s):  
Gherardo Mazziotti ◽  
Andrea Giustina ◽  
Ernesto Canalis ◽  
John P. Bilezikian
Keyword(s):  
Side Effects ◽  
Bone Loss ◽  
Organ Transplantation ◽  
Gastrointestinal Diseases ◽  
Glucocorticoid Therapy ◽  
Skeletal Health ◽  
Effective Strategies ◽  
New Knowledge ◽  
Synthetic Glucocorticoids

Synthetic glucocorticoids are used in a wide variety of disorders including autoimmune, pulmonary, and gastrointestinal diseases, as well as in patients following organ transplantation and with malignancies. Although the indications for glucocorticoids in these various conditions are clear, their use is fraught with a host of potential side effects. In particular, glucocorticoids are detrimental to bone and glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis (1). Despite the fact that glucocorticoids can cause bone loss and fractures, many patients receiving or initiating long-term glucocorticoid therapy are not evaluated for their skeletal health. Furthermore, patients often do not receive specific preventive or therapeutic agents when indicated. New knowledge of the pathophysiological mechanisms underlying GIO has been accompanied by the availability of effective strategies to prevent and treat GIO (1).

scholarly journals Possibilities of use of plant derived nonstarch polysaccharides in clinical practice

2018 ◽  
Vol 26 (2) ◽  
pp. 305-316
Author(s):  
Ivan V. Chernykh ◽  
Ekarina E. Kirichenko ◽  
Aleksey V. Shchulkin ◽  
Natalia M. Popova ◽  
Anna A. Kotlyarova
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Transmembrane Protein ◽  
Modern Medicine ◽  
Herbal Remedies ◽  
Neuroprotective Activity ◽  
Therapeutic Effects ◽  
Wide Range ◽  
Neuroprotective Therapy ◽  
Nonstarch Polysaccharides

Inhibition of Pglycoprotein transporter protein (ABCB1protein, Pgp) is a promising method to increase the effectiveness of pharmacotherapy in different pathologies: neoplastic diseases, epilepsy, cerebral circulation disorders. Pgp is a large transmembrane protein that provides efflux of a wide range of endo and xenobiotics from cells, and plays a significant role in pharmacokinetics of many medical drugs. Nowadays not a single synthetic inhibitor of the transporter is used in clinical practice due to nonselectivity of action, toxicity and high cost. Medicinal herbal remedies possess different pharmacological and therapeutic effects, rarely cause side effects and are economically accessible. This review presents the results of experiments in which affiliation of the oligo and polysaccharides to substrates and inhibitors of Pgp was analyzed, and which precondition further studies of other plant derived polysaccharides. Possibilities of using plant derived nonstarch polysaccharides in complex therapy of tumors are described, since along with potential inhibition of the transporter, they possess an antitumor effect and can also assist in correction of side effects of cytostatics. The prospects of using plant derived nonstarch polysaccharides for improvement of the effectiveness of neuroprotective therapy are presented, because they not only can increase the penetration of neuroprotective drugs across the bloodbrain barrier through Pgp inhibition, but also possess their own neuroprotective activity, as well as a number of pharmacological effects that can give a positive result in the complex treatment of brain pathologies. Thus investigations of plant nonstarch polysaccharides, their isolation and development of medical drugs on their basis is a promising direction of modern medicine.

scholarly journals Possibilities of use of plant derived nonstarch polysaccharides in clinical practice

2018 ◽  
Vol 26 (2) ◽  
pp. 305-316
Author(s):  
Ivan V. Chernykh ◽  
Ekarina E. Kirichenko ◽  
Aleksey V. Shchulkin ◽  
Natalia M. Popova ◽  
Anna A. Kotlyarova
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Transmembrane Protein ◽  
Modern Medicine ◽  
Herbal Remedies ◽  
Neuroprotective Activity ◽  
Therapeutic Effects ◽  
Wide Range ◽  
Neuroprotective Therapy ◽  
Nonstarch Polysaccharides

Inhibition of Pglycoprotein transporter protein (ABCB1protein, Pgp) is a promising method to increase the effectiveness of pharmacotherapy in different pathologies: neoplastic diseases, epilepsy, cerebral circulation disorders. Pgp is a large transmembrane protein that provides efflux of a wide range of endo and xenobiotics from cells, and plays a significant role in pharmacokinetics of many medical drugs. Nowadays not a single synthetic inhibitor of the transporter is used in clinical practice due to nonselectivity of action, toxicity and high cost. Medicinal herbal remedies possess different pharmacological and therapeutic effects, rarely cause side effects and are economically accessible. This review presents the results of experiments in which affiliation of the oligo and polysaccharides to substrates and inhibitors of Pgp was analyzed, and which precondition further studies of other plant derived polysaccharides. Possibilities of using plant derived nonstarch polysaccharides in complex therapy of tumors are described, since along with potential inhibition of the transporter, they possess an antitumor effect and can also assist in correction of side effects of cytostatics. The prospects of using plant derived nonstarch polysaccharides for improvement of the effectiveness of neuroprotective therapy are presented, because they not only can increase the penetration of neuroprotective drugs across the bloodbrain barrier through Pgp inhibition, but also possess their own neuroprotective activity, as well as a number of pharmacological effects that can give a positive result in the complex treatment of brain pathologies. Thus investigations of plant nonstarch polysaccharides, their isolation and development of medical drugs on their basis is a promising direction of modern medicine.

scholarly journals Safety of infliximab in real clinical practice

2019 ◽  
Vol 1 (18) ◽  
pp. 39-43
Author(s):  
E. S. Aronova ◽  
G. V. Lukina
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Reaction ◽  
Case Report ◽  
Clinical Practice ◽  
Side Effects ◽  
Genetically Engineered ◽  
Clinical Rheumatology ◽  
Actual Clinical Practice ◽  
Wide Range ◽  
Real Clinical Practice

A wide range of highly effective genetically engineered biological preparations introduced into clinical rheumatology in recent years causes a special interest in their safety.Purpose of the study. Evaluation of the safety of infliximab therapy in patients with rheumatoid arthritis.Materials and methods. The authors' own data, which analyzed the undesirable effects of infliximab in 135 patients with rheumatoid arthritis in actual clinical practice, are presented. A case report of the adverse reaction of combination therapy with leflunomide and infliximab is presented.Results and its discussion. The overall tolerability of infliximab was satisfactory. Adverse events were observed in 28.1 % of cases, including 19.1 % of patients (14.1 %) had serious side effects that required discontinuation of the drug.Findings. In most cases, infliximab is safe for use in actual clinical practice. Patients should be informed about the risks of undesirable effects and the need for a rheumatologist's examination before each infliximab administration before prescribing therapy.

scholarly journals Pharmacogenomics: introduction and use in clinical practice

2020 ◽  
Vol 58 (2) ◽  
pp. 69-74
Author(s):  
Hollie Saunders ◽  
Dana Harris ◽  
Răzvan M. Chirilă
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Adverse Effects ◽  
Genetic Code ◽  
Drug Response ◽  
Effective Response ◽  
Basic Principles ◽  
Direct To Consumer ◽  
Wide Range ◽  
Consumer Testing

AbstractPharmacogenomics describes the link between the genetic code and variations in drug response or adverse effects. It is rapidly gaining in both interest and accessibility. The knowledge of the gene-drug pairing for a wide range of medications will allow the clinician to select drugs with the best efficacy, appropriate dose and lowest likelihood of serious side effects.In order to apply this knowledge, practitioners need to be familiar with the basic principles of pharmacodynamics and pharmacokinetics and how these relate to drug response. Once these are understood, so can be the genetic variations that lead to different phenotypes. Our review explains these concepts and uses examples of commonly prescribed medications and their gene pairings. At the present time, the Food and Drug Administration (FDA) guidelines remain sparse in regards to pharmacogenomic testing but, despite this, direct-to-consumer testing is widely available. In this context, we detail how to interpret a pharmacogenomic report, we review the indications for testing, as well as its limitations.This information is a step ahead towards invidualized medicine, in the hope that tailoring medications and doses to an individual’s genetic make-up will predict a safe and effective response.

scholarly journals Side Effects of Long - Term Glucocorticoid Therapy: Case Report

2021 ◽  
Vol 26 (2) ◽  
pp. 23-25
Author(s):  
Ioana-Codruţa Lebădă ◽  
Elena Teodora Măerean ◽  
Roxana-Florina Inţă
Keyword(s):  
Side Effects ◽  
Adrenal Insufficiency ◽  
Glucocorticoid Therapy ◽  
Term Therapy ◽  
Self Administration ◽  
Mixed Dyslipidemia ◽  
Radiological Changes ◽  
One Year ◽  
Long Term Therapy

Abstract Glucocorticoids are one of the most common classes of drugs used to treat a diverse variety of inflammatory and autoimmune disorders. Despite their effects, long-term therapy exposes patients to multiple side effects, such as weight gain, high blood pressure, adrenal insufficiency, osteoporosis and a high risk of infections. We present the case of a 61-year-old female with osteoporosis secondary to glucocorticoid therapy, adrenal insufficiency, new-onset diabetes mellitus and mixed dyslipidemia, manifestations that occurred as a result of self-administration of Medrol for one year. The patient presented to the hospital for thoracic back pain, being sent to the endocrinologist due to radiological changes suggestive of vertebral compressions.

scholarly journals Nivolumab Induced Multiple Endocrinopathies; Adrenal Insufficiency and Primary Hypothyroidism in a Patient With Stage IV Gastric Cancer - A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A145-A145
Author(s):  
Randa Abdelmasih ◽  
Ramy Abdelmaseih ◽  
Rima Gandhi ◽  
Marines Faya ◽  
Josef James Karl Vesely
Keyword(s):  
Side Effects ◽  
Adrenal Insufficiency ◽  
Human Monoclonal Antibody ◽  
Laboratory Data ◽  
Stage Iv ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Pituitary Cells ◽  
Acth Stimulation ◽  
Wide Range

Abstract Introduction: Nivolumab is a revolutionary immune check point inhibitor (ICI) that changed the world of oncology. It prevents interaction of Program Death Receptor-1 (PD-1) and Program Death Ligand-1 (PD-L1) releasing a cascade of anti-tumor response. However, it has been associated with wide range of autoimmune side effects including gastrointestinal, hepatic, and endocrine side effects. The incidence of nivolumab induced endocrinopathies is relatively rare but increasingly reported. Adrenal insufficiency occurring in <1% of patients, hyperthyroidism in 15.3% and subclinical hypothyroidism in 4.2%. Case Presentations: 81 year old male with stage IV stomach cancer treated with Nivolumab. Prior to immunotherapy initiation, a set of baseline hormones was obtained and was within normal range. 6 months after, routine monitoring showed elevated thyroid stimulating hormone 6.33 mU/L and low FT4 0.59 ng/dL and FT3 0.1 ng/dL. Patient was started on thyroid replacement therapy. After 1 year of Nivolumab therapy, he presented with dizziness and orthostatic hypotension. Laboratory testing was remarkable for low sodium 130 mEq/L, which raised concerns for adrenal insufficiency. Subsequently, ACTH stimulation test showed low cortisol level 15 mcg/dL. Morning cortisol was also low 1.3 mcg/dL. Other pituitary hormones were normal. Patient was started on hydrocortisone with subsequent improvement of symptoms. Discussion: Nivolumab is a human monoclonal antibody that blocks PD-1 and turns off the tumor mediated immune system inhibition. In the meanwhile, ICI also disrupt normal immune signaling mechanisms that lead to decrease immune tolerance and autoimmune diseases. The mechanism of thyroid dysfunction due to ICI remains unclear. PD-1/PD-L1 blockade could induce thyroiditis by diminishing regulatory T cells function. Disruption of interaction between PD-1-expressing lymphocytes and PD-L-expressing thyrocytes –which protects the thyroid gland from autoimmunity– leads to infiltration of the thyroid with autoreactive T and B lymphocytes. Nivolumab induced Adrenal insufficiency is an extremely rare and unclear event, currently, there is no clear evidence that pituitary cells express PD-1. Recently, it was found that the PD-L1 and PD-L2 are expressed in mouse anterior and intermediate pituitary gland, but not the posterior pituitary. This suggests the possibility that specific injury can take place affecting only certain anterior pituitary cells, such as those producing ACTH. Awareness of such endocrinopathies is crucial. Patients should have certain baseline of laboratory data prior to therapy initiation and over the course of treatment. The risk of endocrinopathies is greater at the start of treatment, justifying closer monitoring every visit over the first 6 months, followed by regular monitoring every second visit over the next 6 months and less frequently thereafter.

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