Endocrine-Hypo, pituitary, thyroid Flashcards
What is special regarding Pituitary gland? Consider in all dysfunction of life
PITUITARY HORMONES
Short half-life
NO PO-Rapidly digested by peptidase enzymes
Regulate by Hypothalmus release/inhibitory
Growth, BP, pregnancy childbirth, milk, sex organs, thyroid, conversion to energy/metabolism, water balance kidneys, temp.
RX
SQ, IM, IV
Regulatory negative feedback loops
WHat drugs affect the Endocrine Diseases?
Types of drugs:
Hormone replacement
Stimulate hormone release
Inhibit hormone release- DOPAMIN AND SOMATROPIN RELEASE INHIB/SOMATOSTATIN***
How do Gonadotropin Releasing Hormones work? What are mainstay in Gonadtrophin RX?
Regulates sex hormone synthesis- LH, FSH
GnRH- hypothalamus in pulses- via hypothalamic-pituitary portal system to AP
Stimulates ovary/testes to produce hormones
AXIS- regulating sex hormone synthesis
GnRH will bind to the GnRH receptor in AP- GPCR
activate secondary messenger system signaling leads to the production of LH an FSH
MAINSTAY in vitro fertilization
Control ovarian stimulation
follicle development
sperm production
How are Gonadotropins produced and what is MOA?
Produced by gonadotroph cells in AP
FSH - Stimulate ovarian follicle development
FSH + LH - Needed for ovarian steroidogenesis
Human chorionic gonadotropin (hCG)-Produced by the placenta, Regulate reproductive functions
What are the target cells for LH and FSH?
Target cells in males:
Leydig cells
Sertoli cells
Target cells in females:
Thecal cells
Granulosa cells
What are the Clinical use of Gonadotropins Replacement
Menotropins?
from PMP urine has unused hormones, high FSH, LH
MOA-Induce FSH LH, thus ovulation, ovary development in patients with functional oligo or anovulation.
Males off label- LH- spermatogenesis in primary or secondary hypogonadotropic hypogonadism
ADE- multiple pregnancy, GDM, preclampsia, preterm, ovarian-enlarged, hypovolemia, fever
What are the differences btwn FSH Replacement
Urofollitropin and Follitropin alfa Lutropin?
Urofollitropin (Bravelle)- FSH ONLY urine
MOA: stimulates ovarian follicular growth who DO NOT have primary ovarian failure. (dfx in ovaries b4 40y, no estrogen and no release of eggs)
Follitropin-Recombinant FSH-FAKE, identical to human FSH. Shorter half-life
MOA: stimulate ovarian follicular growth in growth who DO NOT have primary ovarian failure.
M-stimulate spermatogenesis in men with hypogonadotrophic hypogonadism
Lutropin alfa- (luveris) LH ONLY Added
w/ Follitropin for infertile women w/ LH deficiency.
MOA- inc. follicular estradiol secretion, need for FSH induced follicular development/maturation.
What are Gonadotropins ADRs?
HA, depression, edema, precocious puberty, hCG antibody production (rare) Reversible, Gynecomastia
Serious Multiple pregnancies 15-20% in ovulation induction (1% general population) GDM preeclampsia, preterm labor
Ovarian hyperstimulation syndrome (OHS)
Ovarian enlargement, ascites, hydrothorax, hypovolemia, fever, arterial thromboembolism, shock
What are GnRH Agonists Uses for? gonadorelin goserelin histrelin **leuprolide (Lupron) naferelin triptorelin
Uterine benign fibroids
Central precocious puberty- early secondary sex characteristics
Advanced ovarian and breast cancer
thinning of endometrial lining,
PCOS-amenorrhea infertility
Prostate cancer- testosterone suppression, NON pulsitile
Blocks LH surge in IVF protocols
Endometriosis-block cyclic changes
Estrogen-sensitive endometrium-like tissue outside the uterus, < 6 months, d/t bond density
What are MOA of GnRH Agonists
Reg. FSH, LH from pituitary Pulsatile INC promots ovulation Continusous- inhibits FSH, LH, treat hormone sensitive cancers Synthetic IM, SC, nasal spray IV
What do the GnRH Antagonists do and clinical use?
inhib FSH and LH release
Prevent LH surge
Reduces testosterone prostate cancer
-RELIX
What drugs are avail. for HYPOprolactinemia?
NONE**
What hormone released form hypothalamus inhibits prolactin release in pituitary?
Dopamine
Any RX for treatment of Psychosis will have MOTOR effect
Any RX for treatment of Parkinson will have psychos effect
How is prolactin regulated?
Not by NEGATIVE feedback
PRL NO stimulate hormone release on its target organ
Ex. produces milk, milk does not feedback to hypothalamus
Made by lactotrophs in the AP
What drug will release PRL?
***Phenothiazine
ANY Dopamine antagonist will INC prolactin release
What is the only formulation for treating HYPERprolactemia?
Bromocriptine- PO
Cabergoline-PO, VAG
MOA-DA agonists- promotes DA to inhibit PRL
DEC GH in acromegaly- extra bone after epiphyseal plates fuse
Parkinson- risk psychosis
Shrink tumors
ADR:
Psychosis
Pulmonary infiltrates and fibrosis, ORTHO HTN
MC for HYPERprolactemia?
1-PRL-secreting adenomas
PRL MOA: supress HYPO-PIT- AXIS
inhibits GnRH-DEC LH FSH- body saying no more eggs we already prego.
HYPOgandism, infertility
- ANY Dopamine antagonist
What is produced by hypothalmus and releasded by post pituitary and involves lactation? the LOVE HORMONE
Oxytocin (Pictocin) similar to ADH (vasopressin) milk ejection stimulate uterine contractions High dose can effect vasopressin receptors
MOA- labour induction, STOP postpartum bleeding
ADRs-Rare
excessive contractions
vasopressin activation- water retention/water toxic, hyponatremia, CV, seize, death
AVOID-Fetal distress, uterine rupture
What is released due to plasma concentration DEC, dec. blood pressure?
ADH- ANTI (retention) diruetic hormone
Drug Vasopressin
What is 4000x great than natural ADH?
desmopressin vaspressin Analog
IV, SC, INH
MOA- specificity for V2 receptors stimulates water retention.
cause urinary retention
DOC- poly-uria, dipsia, DI, , hyernatremia, bedwetting
IV- bleeding, coagulpathies- Hemophilia A, Willebrand- platelet adhesion dfx
1:10000 Pt has a h/o CAD, HA, nausea, HYPOnatremia, vascocontstriction? What are these ADR associate with?
Vasopressin
What is used for treatment of CHF and Acute heart failure?
Vasopressin Antagonists
MOA- opposite of water retention. Releases fluid overload, thus dec pressure
What have a NEG log linear relationship?
FREE T4 and TSH
small change in T4= Large change in TSH
Which is best for assessment of thyroid?
Which is best to rule out Pituitary (secondardy) vs Hypothalmaic (tertiary) dz
TSH- somthing is off
T4- HPO
TSH- normal- NO further test
HIGH TSH= HYPOthyrodism (LOW T4 degree of HPO)
LOW TSH= HYPERthryodisim (HIGH T3/T4 degree) (Thyroid overstimulating, so TSH shuts down dramatically bc neg feedback, thinks enough)
