Hormonal therapy stress

It must be stressed that hyperphosphatasemia in uncomplicated liver or bone disease, although of academic interest, has never posed a mystery of interpretation to the clinician nor has it confused the grounds for his decision making. The problem has arisen principally in dealing with laboratory findings in coexisting liver and bone disease, especially where a sudden elevation has occurred in the serum phosphatase level, as in hormonal therapy of cancer of the breast or of the prostate. 

Most important, glucocorticoids should not be withdrawn abruptly in cases of acute infections or severe stress, such as surgery or trauma. Myasthenia gravis, peptic ulcer, diabetes mellitus, hyperthyroidism, hypertension, psychological disturbances, pregnancy (first trimester), and infections may be aggravated by glucocorticoid administration. Hormone therapy is contraindicated in these conditions and should be used only with the utmost precaution. 

I. Replacement therapy. The adrenal cortex (AC) produces the glucocorticoid cortisol (hydrocortisone) and the mine-ralocorticoid aldosterone. Both steroid hormones are vitally important in adaptation responses to stress situations, such as disease, trauma, or surgery. Cortisol secretion is stimulated by hypophyseal ACTH, aldosterone secretion by angiotensin 11 in particular (p. 124). In AC failure (primary AC insuffiency ... 

The Million Women Study in the UK (18) has been criticized on various grounds by some proponents of hormone replacement therapy, notably because in their view the number of deaths from breast cancer was too small and the follow-up too short to justify the belief that HRT increases the risk of death from breast cancer discrepancies between this and other studies have also been stressed (19). The interpretation of the study in the editorial that accompanied it has also been criticized as being unduly pessimistic. However, the fact remains that the study is not the only source of serious doubts about the benefit to harm balance of hormone replacement therapy. 

The complexity of the relation between hormonal replacement therapy and breast cancer has been stressed in previous volumes (SED-14, 1454) (SEDA-22, 465), and much depends on the type of replacement therapy given and the class of tumor studied. This latter point has been underscored by a US study that provided evidence that the use of combined hormonal replacement therapy increases the risk of lobular, but not ductal, breast carcinoma in middle-aged women (28). 

L7. Leal, M., Diaz, J., Serrano, E., Abelian, J., and Carbonell, L. F., Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes. Obstet. Gynecol. 95, 804-809... 

Prednisolone - The stress of surgery causes an increase in plasma adrenocorticotrophic hormone and cortisol concentrations. Cortisol secretion can rise from 30 mg/day to 50 mg/day following minor surgery and 150 mg/day following major surgery. However, an abrupt withdrawal after a prolonged period may lead to acute adrenal insufficiency, hypotension or shock. Thus it is important to continue SC s corticosteroid therapy and additional intravenous hydrocortisone may be administered peri-operatively. 

The initial dose of levothyroxine is dependent on the patient s age, and the presence of associated disorders, as well as the severity and duration of hypothyroidism. In young patients with longstanding disease and patients over age 45 without known cardiac disease, therapy should be initiated with 50 meg daily of levothyroxine and increased to 100 meg daily after 1 month. The recommended initial daily dose for older patients or those with known cardiac disease is 25 meg per day titrated upward in increments of 25 meg at monthly intervals to prevent stress on the cardiovascular system. Some patients may experience an exacerbation of angina with higher doses of thyroid hormone. Although the TSH is very sensitive for under- or overreplacement, chnicians often fail to alter the dose of T4 based on TSH clearly outside of the normal range. ... 

In DKA the major culprit is insulin deficiency. Insulin deficiency may be relative, for example, in the setting of severe infection, where normal amounts of insulin are insufficient or absolute when insulin therapy is neglected. At some stage insulin deficiency becomes coupled with an excess of counter-regulatory hormones and cytokines [9,10]. The traditional catabolic (stress) hormones include glucagon, epinephrine. 

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