ENDOCRINE IMPACT OF VOLUNTARY ACUTE ORGANOPHOSPHORUS POISONING - CASE SERIES

Cristian Cobilinschi; Radu Țincu; Adina Rusu; Alexandra Totan; Claudia Oana Cobilinschi; Ioana Marina Grințescu

doi:10.33695/rjcr.v4i2.78

Cristian Cobilinschi Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital & Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Radu Țincu Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital & Department of Toxicology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Adina Rusu Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Alexandra Totan Department of Biochemistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Claudia Oana Cobilinschi Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Internal Medicine and Rheumatology, Sf Maria Clinical Hospital, Bucharest
Ioana Marina Grințescu Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital & Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/rjcr.v4i2.78

Keywords: organophosphorus, pesticides, poisoning, suicide, hormonal imbalance, sick euthyroid syndrome

Abstract

The high rate of suicide worldwide represents a major global health problem and using self-poisoning with pesticides is a commonly used method. Organophosphorus (OP) compounds are responsible for a cholinergic crisis in the acute phase, followed by intermediate syndrome and delayed polyneuropathy. While cardiovascular, hepatic and respiratory effects have been extensively studied, hormonal changes secondary to OP pesticide exposure are not fully understood. The aim of this original paper is to assess hormonal status of patients poisoned with OP insecticides in the context of a suicide attempt. A prospective, observational study was developed over one year that included confirmed OP-poisoned patients. Apart from demographical data, blood samples were drawn to determine the plasma level of butyrylcholinesterase and levels of thyroid stimulating hormone (TSH), fT3, free-thyroxine (fT4), cortisol, IGF-1 and prolactin. Repeated dosing was performed upon admission and 24 hours later. Ethical approval was obtained, and statistical analysis used SPSS version 25.0.0 with t-test and Person correlation coefficient. The study group included 15 patients and 8 were excluded due to confounding medical history or drug intake. The mean cortisol level at admission was 50 μg/L. A similar trend was also observed for thyroid hormones, thus in the case of fT3 the initial mean value was 4.02 pg/ml, subsequently decreasing 24 hours after admission to 2.88 pg/ml, p = 0.0011. fT4 also decreased 24 hours after intoxication (p = 0.0015). TSH showed a decrease from the time of admission, but more marked than the other hormones (p = 0.001). A statistically significant difference was also identified between IGF-1 levels on admission and after 24 hours. There was a positive correlation between FT4 and cortisol (r = 0.76), suggesting that in the acute phase of intoxication the cortisol increase is proportional to the increase in fT4. The present study is devoted to describing hormonal changes in OP poisoning. Patients with pre-existing psychiatric dysfunction who resort to OP pesticide intoxication are at risk of enhancing their condition secondary to hormonal imbalance caused by toxic exposure. Follow-up in specialized centers is advisable in these patients.

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