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Endocrine effects of organophosphate antidotal therapy
Salim Satar1, Ahmet Sebe, Metin Topal
1Department of Emergency Medicine, Cukurova University School of Medicine, Balcali/Adana, Turkey.
Abstract:
To determine the endocrine effects of the treatment of organophosphate poisoning, this prospective study was conducted in a university-based emergency department among patients with a history and clinical findings compatible with those of organophosphate poisoning. Thyrotrophin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), progesterone (PRG), adrenocorticotropic hormone (ACTH), cortisol, and testosterone (TST) levels were analyzed before and after treatment with atropine and pralidoxime. The Wilcoxon's sign rank sum (nonparametric) test was used to compare dependent variables before and after treatment. A total of 44 patients (19 male; mean age: 28.5 +/- 12.6 y) were enrolled in the study. Patients were hospitalized for 5.4 +/- 1.3 days. Posttreatment ACTH, cortisol, PRL, FT3, FSH, and PRG levels were significantly lower than pretreatment levels (P < .05). The decrease in TSH, LH, and TST levels did not reach statistical significance, while FT4 levels increased following the treatment (P < .05). Six patients were diagnosed on admission with sick euthyroid syndrome, and 11 patients who were euthyroid on admission developed sick euthyroid syndrome following treatment. ACTH, cortisol, PRL, FT3, FT4, FSH, and PRG levels are affected by acute organophosphate poisoning. The change in hormone levels may result from the effects of neurotransmitters, from the direct effect of the toxic agent, or from stress associated with events leading to the poisoning incident.
Insights
Organophosphate poisoning significantly impacts endocrine function, altering levels of adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), and thyroid hormones post-treatment. Some patients developed sick euthyroid syndrome after treatment.
Area of Science:
- Endocrinology
- Toxicology
- Emergency Medicine
Background:
- Organophosphate (OP) poisoning is a significant public health concern.
- The endocrine system's response to OP poisoning and its treatment is not fully understood.
Purpose of the Study:
- To investigate the endocrine effects of treating organophosphate poisoning.
- To analyze changes in various hormone levels before and after atropine and pralidoxime treatment.
Main Methods:
- Prospective study in an emergency department.
- Hormone level analysis (TSH, FT3, FT4, FSH, LH, PRL, PRG, ACTH, cortisol, testosterone) before and after treatment.
- Statistical analysis using Wilcoxon's sign rank sum test.
Main Results:
- Post-treatment levels of ACTH, cortisol, PRL, FT3, FSH, and PRG were significantly lower.
- FT4 levels increased post-treatment; TSH, LH, and testosterone changes were not statistically significant.
- Six patients had sick euthyroid syndrome on admission; 11 developed it post-treatment.
Conclusions:
- Acute organophosphate poisoning affects ACTH, cortisol, PRL, FT3, FT4, FSH, and PRG levels.
- Hormonal changes may stem from neurotransmitter effects, direct toxicity, or poisoning-related stress.
- Treatment for OP poisoning can alter endocrine profiles, including the development of sick euthyroid syndrome.
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