Ze’ev Hochberg,
Karel Pacak and
George P. Chrousos
Division of Endocrinology (Z.H.), Meyer Children’s Hospital, Haifa 31096, Israel; and Pediatric and Reproductive Endocrinology Branch (Z.H., K.P., G.P.C.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
Correspondence: Address requests for reprints to: George P. Chrousos, M.D., Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, Room 9D42, 10 Center Drive, MSC 1583, Bethesda, Maryland 20892-1583. E-mail: Chrousog{at}mail.nih.gov
Hypersecretion of endogenous hormones or chronic administrationof high doses of the same hormones induces varying degrees oftolerance and dependence. Elimination of hormone hypersecretionor discontinuation of hormone therapy may result in a mixedpicture of two syndromes: a typical hormone deficiency syndromeand a generic withdrawal syndrome. Thus, hormones with completelydifferent physiological effects may produce similar withdrawalsyndromes, with symptoms and signs reminiscent of those observedwith drugs of abuse, suggesting shared mechanisms. This reviewpostulates a unified endocrine withdrawal syndrome, with changesin the hypothalamic-pituitary-adrenal axis and the central opioidpeptide, in which noradrenergic and dopaminergic systems ofthe brain act as common links in its pathogenesis. Long-termadaptations to hormones may involve relatively persistent changesin molecular switches, including common intracellular signalingsystems, from membrane receptors to transcription factors. Thegoals of therapy are to ease withdrawal symptoms and to expediteweaning of the patient from the hormonal excess state. Cliniciansshould resort to the fundamentals of tapering hormones downover time, even in the case of abrupt removal of a hormone-producingtumor. In addition, the prevention of stress and concurrentadministration of antidepressants may ameliorate symptoms andsigns of an endocrine withdrawal syndrome.
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