Chapter 48: Adult Endocrine Medications

The pituitary section covers growth hormone replacement for deficiency states and growth hormone antagonists for acromegaly, requiring monitoring of glucose metabolism and hepatic function. Antidiuretic hormone medications such as desmopressin treat diabetes insipidus by promoting water reabsorption, though careful fluid and electrolyte monitoring is essential to prevent water intoxication. Thyroid hormone replacement therapy, predominantly levothyroxine, addresses hypothyroidism and requires consistent timing and administration protocols to ensure therapeutic efficacy while avoiding toxicity symptoms resembling hyperthyroidism. Antithyroid agents including methimazole and propylthiouracil inhibit thyroid hormone synthesis for managing hyperthyroidism and Graves' disease, with particular concern for agranulocytosis and the risk of thyroid storm with abrupt discontinuation. Parathyroid medications regulate calcium homeostasis through supplementation in hypoparathyroidism and bisphosphonates or calcitonin in hypercalcemia. Corticosteroid therapy encompasses mineralocorticoids for adrenal insufficiency and glucocorticoids for immunosuppression, both requiring careful monitoring for metabolic complications and gradual tapering rather than abrupt cessation. Sex hormone medications including androgens and estrogen-progestin combinations serve replacement and therapeutic roles with distinct toxicity profiles. The diabetes section constitutes a substantial portion covering oral antidiabetic agents with different mechanisms, including biguanides that require contrast dye precautions, sulfonylureas with alcohol interaction potential, and newer agents targeting incretin pathways and glucose reabsorption. Insulin therapy remains fundamental for type one diabetes and poorly controlled type two diabetes, with formulations ranging from rapid-acting to long-acting preparations requiring specific handling and injection site rotation protocols. Noninsulin injectable agents and glucagon complete the diabetes management arsenal for specialized clinical scenarios.