Glucocorticoids

Thyroxine

GH

Thyroxine

Assess HPA axis before starting thyroxine, as starting thyroxine in patients with adrenal insufficiency can precipitate an adrenal crisis

—

GH therapy can lower FT4 levels, so increase of the dose of levothyroxine may be needed

Estrogen

Oral estrogens increase cortisol-binding globulin levels, which can cause elevated serum cortisol (not seen with transdermal estrogen)

Estrogen increases thyroid binding globulin levels, so initiation or increase of the dose of levothyroxine may be needed

Oral estrogen lowers serum IGF-1 levels, so higher doses of GH therapy may be required (this is not seen with transdermal estrogen)

GH

GH decreases conversion of cortisone to cortisol, so higher doses of glucocorticoids may be required

—

—

ADH

AI can mask DI and treatment of AI can unmask DI

—

—

—, not applicable.