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Endocrinological derangements in COPD

Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Administration Hospital, and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA.

CORRESPONDENCE: F. Laghi, Division of Pulmonary and Critical Care Medicine, Edward Hines, Jr. VA Hospital, 111N, 5th Avenue and Roosevelt Road, Hines, IL 60141, USA. E-mail: flaghi{at}lumc.edu

Keywords: Aldosterone, diaphragm contractility, insulin-like growth factor-I, oestrogens, testosterone, thyroid

Received: July 7, 2008
Accepted May 1, 2009

Chronic obstructive pulmonary disease (COPD) is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders, such as those involving the pituitary, the thyroid, the gonads, the adrenals and the pancreas.

The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxaemia, hypercapnia, systemic inflammation and glucocorticoid administration. Altered endocrine function can worsen the clinical manifestations of COPD through several mechanisms, including decreased protein anabolism, increased protein catabolism, nonenzymatic glycosylation and activation of the rennin–angiotensin–aldosterone system.

Systemic effects of endocrine disorders include abnormalities in control of breathing, decreases in respiratory and limb-muscle mass and function, worsening of respiratory mechanics, impairment of cardiac function and disorders of fluid balance.

Research on endocrine manifestations of COPD embraces techniques of molecular biology, integrative physiology and controlled clinical trials. A sound understanding of the various disorders of endocrine function associated with COPD is prudent for every physician who practices pulmonary medicine.