Endocrine Drugs

Question 1

Acromegaly

Answer 1

Too much growth hormone (GH)

• somatostatins (GH inhibitor)
  
  • Ocreotide (50% success)
  • Pegvisomant (95% success)

Question 2

Achondroplasia

Answer 2

too little growth hormone

• HGH 20-24mg/kg/week

Question 3

Hyperprolactinemia

Answer 3

too much prolactin

• dopamine analogs (dopamine inhibits prolactin)
  
  • Cabergoline 0.25mcg PO bid

Question 4

Diabetes Insipidus

Answer 4

too little ADH (central) or kidneys insensitive (nephrogenic)

• Desmopressin 5mcg IM at bedtime then 5-20mcg 1-2x daily

Question 5

Hypogonadism

Answer 5

too little GnRH (decr. LH/FSH)

• testosterone
  
  • Androderm 2-6mg/d transdermal
  • Androgel 20-81mg/d metered pump
  • Depo-testosterone 100-200mg IM q2w

Question 6

Adrenal Insufficiency

Answer 6

too little cortisol

(Addison’s - autoimmune destruction of adrenal cortex)

• replace cortisol
  
  • Hydrocortisone 15-25mg PO qd/bid (x3 if illness)
• replace aldosterone (not needed if 2’ adrenal insufficiency)
  
  • Fludrocortisone 0.1-0.15mg PO qd

Question 7

Adrenal Crisis

Answer 7

• IV saline for volume depletion
• IV hydrocortisone succinate 100mg STAT
• parental hydrocortisone 50-100mg IM q6h until can tolerate oral therapy
• 10% glucose IV for hypoglycemia

Question 8

Adrenal Overproduction

Answer 8

too much cortisol

(Cushing’s)

• tumor/adrenal removal
• corticrope therapy- Cabergoline

Question 9

Primary Hyperaldosteronism

Answer 9

too much aldosterone

(uncontrolled HBP)

• adenoma
  
  • adrenalectomy
• idiopathic
  
  • Spirolactone 12-25mg PO qd

Question 10

Pheochromocytomas

Answer 10

adrenal medulla tumor

(too high catecholamines: adrenaline, noradrenaline, dopamine)

• tumor removal

Question 11

Hypothyroidism

Answer 11

too little T3/T4 (1’) or TSH (2’)

• Synthroid LT4 1.6mg/kg/day then increase by 25mcg until TSH levels 1-2.5 U/L

Question 12

Hyperthyroidism

Answer 12

too high T3/T4

• Atenolol (beta-blocker) 25-50mg PO up to 200mg in 2 divided doses qd to get HR <90
• Thionamides (anti-thyroid drug)
  
  • Methimazole 10mg PO qd (d/c if agranulocytosis)
• thyroidectomy or radioiodine 131 (unless pregnant, nursing, active Grave’s opthalmopathy)

Question 13

Type I Diabetes

Answer 13

• insulin

Question 14

Type II Diabetes

Answer 14

• metformin
  
  • affects liver mitochondria: produces less glucose, improves insulin sensitivity, reduces appetite
  • contraindicated with eGFR < 30, acidosis, hypoxia, dehydration/volume depletion, radiocontrast
• sulfonylureas
  
  • beta cell stimulators
  • Glimepiride, Glyburide, Glipizide
  • “glinides” - shorter acting
    
    • Repaglinide, Nateglinide
• TZDs
  
  • reduce insulin resistance
  • Pioglitazone, Rosiglitazone
• incretins (GLP-1 receptor agonists)
  
  • stimulate insulin in response to oral glucose
  • Exenatide, Liraglutide, Dulaglutide
• gliptins (GPP-4 inhibitors)
  
  • block GLP-1/GIP deactivators
  • Canagliflozin, Dapagliflozin, Empagliflozin

Question 15

DKA

Answer 15

• ABC
• admit to ICU
• Normal saline 500-1000ml/h then 250-500/h in 2-4h
• replenish K+ to 3.3-5.3
  
  • hold insulin until >3.3
• insulin
  
  • low dose IV .1 U/kg bolus
  • infuse at .1 U/kg/h
• when glucose ~200 in DKA or 250-300 in HHS: D5 saline w/ KCl
• IV bicarb if pH <6.9