Endocrine Brandon Flashcards by Brandon Edmondson

How does somatropin compare to GH?

identical 191 amino acid sequence as GH

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What hormone does somatropin resemble?

Prolactin

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When does IGF-1 become dependent on GH?

during first year of life

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When is IGF-1 essential?

prenatal and postnatal growth

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adverse effects of mecasermin

hypoglycemia
intracranial HTN
adenotonsilar hypertrophy
elevated liver enzymes

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What is rhIGFBP-3?

Mecasermin Rinfabate

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GnRH Agonists?

Gonadorelin
Goserelin
Histrelin
Leuprolide
Nafareline
Triptorelin

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hcG bind what receptors?

LH receptors

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When to use GnRH antagonists?

endometriosis
prostate cancer
central precious puberty (early puberty)
breast & Ovarian Cancer

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Which hormones act directly on target tissues?

POV
prolactin
oxytocin
vasopressin

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S/S hyperprolactinemia in males?

loss of libido
infertility

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s.s of hyperprolactinemia in females?

amenorrhea (no menstration)
galactorrhea (random nipple discharge)

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how do antipsychotics affect prolactin levels?

they increase prolactin

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What are the GnRH antagonists?

“relix”
Ganirelix
Cetrorelix
degarelix
Abarelix

cause dose dependent decrease of FSH/LH

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What are ganirelix and cetrorelix used for?

ovarian hyperstimulation procedures

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what are degarelix and abarelix used for?

advanced prostate cancer

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extrarenal V2 receptors do what?

regulate factor VIII and von willebrand factor

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Vasopression toxicity / CI

headache, NV, abd cramps, agitation (al masked by anesthesia)

overdose = hyponatremia > seizure

careful in pts with CAD

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Vasopressin antagonists

Conivaptan
tolvaptan

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conivaptan receptor affinity?

1:1 for V1:V2

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Tolvaptan receptor affinity?

30:1 V2:V1

role in dexamethasone in pediatric patients undergoing tonsillectomy/adenoidectomy?

prevents inflammation, decrase risk of PONV,

Effects of Chronic corticosteroid treatment

insomnia, euphoria, depression, ^ICP
suppression of ACtH, GH, TSH, LH,
PUD (can happen quickly)
fat redistribution to viscera, face, nape of neck, supraclavicular
antagonize the effects of Vit D on Ca reabsorption
^ RBCs and platelets

another name for ACTH?

corticotropin

What hormones use g-protein mediated signal transduction?

FSH, LH, hCG

what is hMG and what class?

humana menopaousal gonadotropin menotropins

three types of FSH?

urofollitropin (uFSH) off market in 2015 Follitropin alpha (rFSH) Follitropin beta (rFSH) last two are synthetic and expensive

What is leutropin alpha?

recombinant LH

When / with what do you use leutropin alpha?

can use with follitropin alpha used in women with profound LH deficiency

what is choriogonadotropin alpha?

rhCG

SE of somatropin?

edema hyperglycemia pancreatitis gynecomastia ^ CYP450 ENZYMES

when do you want to supress gonadotropins?

controlled ovarian hperstimulation endomedtriousus/uterine fibrosis prostate cancer (anti-androgen is primary though) central precioucous puberty

short to medium acting glucocorticoids

hydrocortisone prednisone methylprednisolone

long acting glucocorticoids

betamethasone (25-40) dexamethasone (30)

what primarily controls mineral corticoids?

circulating angiotensin and K

three things that increase cortisol?

stress hypothyroidism liver dz

how is cortisol metabolized and excreted?

liver metabolism urinary excretion but 1% unchanged, 20% cortisone, 30% dihydroxyl ketone metabolites

describe glucocorticoids mech of action?

cortico binding globulin present steroid to cell steroid enters by itself binds heat shock protein and becomes unstable heat shock protein leaves steroid receptor complex forms dimer and enters cell nucleus bind glucocorticoid response element (GRE) regulates gene transcription that regulate growth factors can also bind other transcription factors in nucleus

how many genes are regulated by glucocorticoids?

10-20%

Effects of cortisol?

metabolic catabolic/anti-anabolic anti inflammatory immunosupressive

metabolic effects of cortisol?

All to maintain glucose supply to the brain muscle catabolism (inhibit muscle uptake of glucose) gluconeogenesis ^ glucose > ^ insulin > ^lipogenesis ^ lipase dose related effects of carbs, protein, fat metabolism

where does cortisol have anti-anabolic effects?

bone i.e osteoporosis from cushing syndrome

antiinflammatory effects of cortisol?

decrease distribution, function, concentration of peripheral leukocytes decrease inflammatory cytokines, chemokine and other inflammatory mediators

general immunosupressive effects of cortisol

inhibit phospholipase A decrease COX2 > decrease prostaglandins vasoconstrction

immunosupresive effects of single dose short acting glucocorticoid

^neutrophils decrease lymphocytes

immunosupressive effects of large dose glucocorticoids (20mg/day of prednisone)

decrease antibody production decrease phagocytosis decrease TNF alpha, interleukins, metalloproteins plasminogen factor

effects of cortisol deficency?

impair renal function increase vasopressin secretion issues with fetal lung development

three types of adrenocorticohyperfunction

cushing syndrome chrousos syndrome aldosteronism

how are synthetic corticosteroids absorbed?

rapidly and completely

steroid stress dose for minor stress

2x dose for 23-48 hr

steroid dose for major stress

10x dose for 48-72 hours