RESUMO
RESUMEN La prescripción de carbonato de litio es común en la actividad psiquiátrica cotidiana. El objetivo es identificar las alteraciones endocrinas secundarias y sus bases fisiopatológicas. La revisión de la literatura se realizó en Psycinfo, EMBASE, PubMed y Scopus. Se efectuó una búsqueda computarizada de información utilizando la estrategia PICO. Las alteraciones más comunes están en riñones, tiroides, paratiroides, páncreas y vías neuroendocrinas. Los mecanismos fisiopatológicos subyacentes son diversos, y destacan la inhibición de la adenilato ciclasa tiroidea sensible a tirotropina como causa de hipotiroidismo, la expresión reducida de acuaporina 2 como causa de diabetes insípida nefrogénica, la pérdida del equilibrio iónico del calcio y la presencia de hiperparatiroidismo e hipercalcemia. En el eje hipotálamo-hipófiso-adrenal, se documenta una disminución en la producción de catecolaminas. Finalmente, se documenta la desregulación en el control de la glucemia al aumentar la resistencia a la insulina. Es necesario conocer estas eventualidades e identificarlas tempranamente a través de evaluaciones periódicas. Se propone un esquema de evaluación integral, sin que implique un algoritmo de tratamiento.
ABSTRACT The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carbonato de Lítio , Rim , Lítio , Glândulas Paratireoides , Glândula Tireoide , Glândulas Suprarrenais , Diabetes Insípido NefrogênicoRESUMO
The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.
