Day 1 Hormones Flashcards
What are the adrenal gland hormones?
What is cushings syndrome?
How does cushings syndrome present?
Aldosterone, Cortisol, Androgens.
Result of excess glucocorticoids(cortisol). Endogenous overproduction is rare. Common if on long term steroid therapy.
Central obesity, face rounding.
How do you treat cushings syndrome?
What are the steroidogenisis inhibitors?
How does mitotane work?
Exclude administration of steroids and progestins–> first line management is surgery–> 2nd line management is pharmacy treatment.
Metyrpaone, Ketoconazole, Etomidate.
cytotoxic medicine(chemo), inhibits cortisol production.
What are the neuromdulators of ACTH release?
How does mifepristone work?
What are Ketoconazole’s ADR’s?
Cabergoline, Pasirotide
Glucocorticoid receptor blocking.
Hepatoxicity, dermatologic reactions and GI upset, Gynecomastia. Strong CYP3A4 inhibitor.
What do we need to monitor on Ketoconazole?
What are Metyrapone’s ADR’s?
What do you monitor and special comments about Metyrpaone?
Liver function
Hirutism, Acne, Blood pressure and electrolyte abnormalities, N/V and vertigo, headache, rash.
Monitor blood pressure and electrolyte, Only available from manufacturer for compassionate use.
What to know about etomidate? What are it’s side effects?
What to monitor for etomidate?
What are the ADR’s of mitotane?
Parentereal anesthetic agent, reserved for emergency and surgery. Sedation, Hypotension, N/V.
Serum cortisol, sedation scores.
Adrenocorticol atrophy, Anorexia, Ataxia and somnolence, GI upset, nausea, diarrhea(administer with food), Lethargy. Monitor cortisol levels.
What are the ADR’s of Cabergoline?
What special things to know about Cabergoline?
What are the ADR’s of Pasireotide?
Nausea, Orthostasis, Headache, Vivid dreams, Psychosis, valvulopathy, monitor via echocardiogram.
D2 receptor agonist, Sustained efficacy in 30-40% of patients, Monitor via echocardiogram.
GI ADR’s, Hyperglycemia, Bradycardia, QT prolongation, Gallstones, Elevated AST/ALT.
What special things to know about Pasireotide?
What special things to know about Mifepristone?
What drug do we use to treat an adrenal adenoma?
Somatostatin analogue,Monitor serum glucose and LFT’s.
Pregnancy test monitoring, serum potassium(hypokalemia)
Ketoconazole
What drug do we use to treat and adrenal carcinoma?
What drug do we use to treat pituitary dependent?
What drugs do we use to treat Ectopic ACTH syndrome?
Mitotane
Mitotane, Metyrapone,Cabergoline, Pasireotide
Metyrapone, Ketoconazole.
What does the adrenal medulla secrete?
What are the symptoms of Pheochromocytoma?
How do you treat pheochromocytoma?
Catecholamines.
Hypertension, Headache, Palpitations and tachycardia, excessive sweating.
Surgical removal of the tumor, BP> 160/90(Alpha adrenergic antagonists primarily used).
What causes addisons disease?
What is the clinical presentation of addisons disease?
How do you manage addisons disease?
results from destruction of adrenal cortex(autoimmune disease, tuberculosis, medications). Secondary causes are Exogenous steroid use.
Hyperpigmentation of skin, weight loss, fatigue, hyponatremia and hyperkalemia, dehydration.
Cortisol supplementation.(Hydrocortisone, cortisone, prednisone). Stress/illness/etc may require increased requirement, mineralcorticoid supplementation to maintain K levels.
What are the counseling points for addisons disease?
What is the most common cause of adrenal crisis?
What are the acute adrenal insufficiency?
Do not stop taking Glucocoritoid replacement. Carry a medical alert card,Have easy access to injectable or suppository or stress dose.
abrupt withdrawal of chronic glucocorticoid.
weakness, weight loss, vomiting, shock, etc.
Where is prednisone and cortisone activated?
What are some short term side effects associated with steroids?
What are some long term side effects associated with steroids?
The liver.
Hyperglycemia, insomnia, fluid and sodium retention, hypertension, pancreatitis, GI upset and weight gain(increased appetite).
Adrenal insufficiency if stopped abruptly, cushings syndrome, diabetes, delayed growth, etc.
What are glucocorticoid clinical pearls?
What to watch for with adrenal suppresion?
What are the posterior pituitary hormones?
Appropriate doses, single large doses probably wont cause side effects, short course therapy unlikely to hurt, incidence increase with dose and duration.
Can occur to some degree when agents are used for >7 days, need taper if >14 days. Doses should be slowly tapered after prolonged suppressive therapy(may take 9-12 months for cortisol secretion to return if on therapy >1 year).
Oxytocin, Vasopressin(antidiuretic hormone).
What do you see in destruction of pituitary gland?
What do you see in pituitary tumors?
Does IGF-1 or IGF-2 happen in utero?
Growth hormone deficiency, panhypopituitarism.
Acromegaly, Hyperprolactinemia.
IGF-2. IGF-1 happens after birth.
What are the treatment options for acromegaly?
What to know about the dopamine agonists in acromegaly?
What are the somatostatin analogues?
Primary is surgery. Other treatment options are radiation and pharmacologic.
Cabergolamine, Bromocriptine.(Dopamine agonists increase GH in healthy adults, in those with acromegaly it paradoxically decreases it).
Ocreotide, Lanreotide, Pasireotide. They inhibit GH secretion.
How does pegvisomant work?
What is 1st line therapy foracromegaly?
When do you use recombinant growth hormone?
Binds to GH hormone receptors but doesn’t activate it.
Somatostatin analogues–> next is dopamine agonists and pegvisomant.
Adult GH deficiency, children with documented GH deficiency.
What are the clinical pearls to know about recombinant growth hormone?
What do you monitor for growth hormone deficiency?
what medications cause hyperprolactinemia?
Continue therapy until height is reached, glucocorticoids may decrease effects of recombinant growth hormone, initiate as early as possible, products are equally effective but you can’t switch them out one with another.
height, weight, growth velocity, Serum IGF-1 concentrations, bone age, serum glucose, thyroid function.
Antipsychotics,metoclopramide, domperidone, Antidepressants, estrogen, progesterone, methyldopa.
What is mecasermin’s side effect?
How to treat hyperprolactinemia?
Can cause hypoglycemia(start at low dose, administer within 20 minutes or a snack, skip dose if patient cannot eat).
Dopamine agonists.
