Endo: Pituitary Pharm

Question 1

Somatotropin

• What is it?
• Use? (4)
• Route?

Answer 1

• Stomatotropin is a GH analog
• Use: children with GH deficiency, Turner’s syndrome, Prader-Willi, wasting in AIDS patients
• Route: injection (SC or IM)

Question 2

How do the following affect GH release?

• Exercise
• GHRH
• Hyperglycemia
• Dopamine
• Somatostatin

Answer 2

• Exercise: stimulates GH release
• GHRH: stimulates GH release
• Hyperglycemia: inhibits GH release
• Dopamine: Normally, DA stimulates GH release. But, DA inhibits GH release in acromegaly
• Somatostatin: inhibits GH release

Question 3

What is Laron syndrome?

How is it treated?

ADR (1)

Answer 3

• Laron syndrome: GH receptor mutation
• Tx: Mecasermin (IGF-1 analog)
• ADR: hypoglycemia

Question 4

Can you use GH off-label for treatment of aging?

Answer 4

No. Use of GH off-label is illegal

Question 5

Somatotropin ADR (2)

Answer 5

• insulin resistane
• idiopathic intracranial HTN

Question 6

Name 2 somatostatin analogs

How are they administered?

Answer 6

Octreotide

Lanreotide

Both injections

Question 7

Name 3 medical treatments for acromegaly

Answer 7

• Octreotide (somatostatin analog)
• Pegvisomant (GH receptor blocker)
• Cabergoline (DA agonist)

Question 8

What is the preferred medical tx for esophageal varice bleeding?

Answer 8

Octreotide

(it has fewer side effects than vasopressin)

Question 9

ADR of octreotide (4)

Answer 9

• Steatorrhea/loose stools
• Cholelithiasis
• Hyperglycemia
• Cardiac effects

Question 10

What type of receptor does Somatostatin use?

Answer 10

Gi

Question 11

• PRL release is stimulated by ______
• PRL release is inhibited by __________
• PRL release itself inhibits ___________ release

Answer 11

• PRL release is stimulated by suckling
• PRL release is inhibited by dopamine
• PRL release itself inhibits GnRH release

Question 12

What is the name of the pathway in which dopamine inhibits PRL release?

Answer 12

Tuberoinfundibular pathway

Question 13

Tx for hypoprolactinemia

Tx for hyperprolactinemia

Answer 13

• HYPOprolactinemia: no tx
• HYPERprolactinemia: D2 agonists (Cabergoline is first line, then bromocriptine)

Question 14

Compare cabergoline and bromocriptine

ADR (3)

Answer 14

Cabergoline is first line for prolactinoma

ADR of bromocriptine: N/V, headache, hypotension

Question 15

What stimulates ADH release?

What inhibits ADH release?

Answer 15

ADH release is

• stimulated by increased plasma osmolality or decreased blood volume
• inhibited by ethanol (why you pee when you drink)

Question 16

What is the treatment for central DI?

ADR (4)

Answer 16

• Treat central DI with desmopressin (DDAVP)
• ADR: Headache, GI symptoms, weakness, hyponatremia,

Question 17

Compare administration of ADH and DDAVP

Answer 17

• DDAVP can be given orally or parenterally
• ADH can only be given parenterally

Question 18

What drug can treat central DI if intolerant to desmopressin?

Answer 18

Chlorpropamide (sulfonylurea)

Question 19

Tx of nephrogenic DI (2)

Answer 19

• Thiazide diuretics
• Indomethacin
  *

Question 20

4 Drugs that can cause SIADH

Answer 20

• Sulfonylureas
• Neuro drugs (SSRI’s, haloperidol, etc)
• Vincristine/vinblastine
• MDMA

Question 21

Tx of SIADH (4)

Answer 21

• Water restriction, hypertonic saline
• demeclocycline
• Lithium
• Vaptans (V2 receptor blockers)