DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

In the currently overwhelming era of polypharmacy, the balance of the dynamic and delicate endocrine system can easily be disturbed by interfering pharmaceutical agents like medications. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the feedback axis, on hormonal transport, binding and signaling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can interfere with the hormonal assays, leading to erroneous laboratory results that disorientate clinicians from the right diagnosis. The purpose of this review is to cover a contemporary topic, the drug-induced endocrinopathies, which was presented in the monothematic annual Combo Endo Course 2018. This challenging part of endocrinology is constantly expanding particularly during the last decade, with the new oncological therapeutic agents, targeting novel molecular pathways in the process of malignancies. In this new context of drug-induced endocrine disease, clinicians should be aware that drugs can cause endocrine abnormalities via different mechanisms and mimic a variety of clinical scenarios. Therefore, it is extremely important for clinicians not only to promptly recognize drug-induced hormonal and metabolic abnormalities, but also to address the therapeutic issues for timely intervention.

Spironolactone interference in the immunoassay of androstenedione

Background

In an evaluation of androstenedione results from patient serum samples using the Siemens Immulite 2500 analyser and manual Coat-A-Count (CAC) methods, three outliers were evident with grossly elevated results in the CAC assay.

Methods

The clinic notes of three patients with apparently high serum androstenedione concentrations by the CAC assay were checked for medications. The samples were all from patients with polycystic ovary syndrome taking 100–200 mg/d of a steroidal antiandrogen (spironolactone). Two other patients on 50 mg spironolactone per day had less markedly higher androstendione results with the CAC assay. In a further five patients who were selected since they were on spironolactone and had high androstenedione results by the CAC method, spironolactone was temporarily withdrawn and fresh blood samples obtained for analysis.

Results

Spironolactone treatment was associated with higher androstenedione concentrations measured by the CAC assay that reverted to normal on treatment withdrawal. Based on a single test with spironolactone at 1000 ng/mL, the manufacturer reported only 0.109% interference in the CAC assay.

Conclusions

Spironolactone (and/or its metabolites) may interfere in the Siemens CAC assay for androstenedione but not in the Immulite 2500 assay. This experience highlights the need for information from clinicians on drug treatment when laboratory investigations are requested. Drug interferences in immunoassay are common and need evaluation beyond tests performed to certify laboratory reagents.

Smoking habits among the hospital staff of a General Hospital in northern Greece: a long way for smoke-free hospitals

BACKGROUND AND AIM

The aim of the study was to evaluate the smoking habits of all staff working in a General Hospital, and to examine whether these habits comply with the introduction of a tobacco law in July 2002, where smoking in enclosed public areas, including hospital buildings, has been forbidden in Greece.

METHODS

All hospital staff in Serres General Hospital was asked to complete and return a questionnaire about their smoking habits. The questionnaire was voluntary and anonymous. The survey was conducted from October 2003 to January 2004.

RESULTS

Six hundred and twenty three (74%) of the 847 members of staff responded; 310 (50%) were current smokers and 313 (50%) were non-smokers of whom 101 (32%) were ex-smokers. The prevalence of current smokers was the highest among nurses (57%) and the lowest among doctors (31%). Male smokers (42%) were outnumbered by female smokers (54%) in all age groups up to the age of 60 years (p<0,01), although the reverse is the trend in Greek population (47% and 29%, respectively). The highest rate of smokers was found at the age group of 31-40 years (60%), while these above sixty years had the smallest (29%). Seventy percent of current smokers had at least one family member who was current smoker vs 49% of non-smokers (p<0,001). The vast majority of smokers (94%) continued to smoke in hospital, of whom 62% smoke more than 5 cigarettes while at work.

CONCLUSIONS

The high rate of smokers among the health professionals compared to those in the general population would probably have a negative influence on the development, implementation and inspection of workplace smoking bans in Greece. Increased efforts to promote tobacco education and intervention among doctors and nurses and to establish specialist smoking cessation services throughout the National Health Service should be the standard component of antismoking policy for the law to be effective.