ERS L11 - Treatment of Pituitary Disorders

Question 1

Somatotropin replacement

Answer 1

For pituitary dwarfism.

Direct stimulation to increase protein synthesis and amino acid uptake. Increase lipolysis (after a few hours). Increase glucose level (after a few hours).

Indirectly stimulate bone growth by stimulation of IGF-1 production from liver.
Increase sulphate uptake into cartilage.
Promote bone growth by stimulating thymidine and uracil incorporation into DNA and RNA respectively.

Question 2

Follitropin

Answer 2

Recombinant human FSH

Question 3

Lutropin alpha

Answer 3

Recombinant human LH

Question 4

Human chorionic gonadotropin

Answer 4

As LH replacement

Question 5

Human menopausal gonadotropin

Answer 5

For FSH replacement

Mixture of FSH and LH

Question 6

Choriogonadotropin alpha

Answer 6

Recombinant HCG

Question 7

FSH replacement

Answer 7

*must add LH replacement for treating hypogonadism

Follitropin
Human menopausal gonadotropin

Question 8

LH replacement

Answer 8

*add FSH replacement

Lutropin alpha
HCG
Choriogonadotropin alpha

Question 9

For primary hypoadrenalism, eg Addison’s disease

Answer 9

Hydrocortisone/cortisone + fludrocortisone

Question 10

Hydrocortisone

Answer 10

Corticosteroid, mainly with glucocorticoid function

Question 11

Cortisone

Answer 11

Converted to hydrocortisone in liver

Corticosteroid, mainly glucocorticoid function

Question 12

Fludrocortisone

Answer 12

Mineralosteroid

Question 13

Secondary hypoadrenalism

Answer 13

Corticosteroid with glucocorticoid function only

Question 14

Somatotropin: side effects

Answer 14

Hypothyroidism
Glucose intolerance
Peripheral edema
Papilledema, visual changes
Increased intracranial pressure, headache

Question 15

FSH replacement: side effects (X8)

Answer 15

Ovarian hyper simulation syndrome (ovarian enlargement, hydrothorax, ascites, hypovolemia)

Haemoperitoneum
Dyspnea
Electrolyte imbalance
Arterial thromboembolism
Fever 
Multiple births 
Gynecomastia

Question 16

LH replacement: side effects

Answer 16

Headache
Depression
Edema 
Precocious puberty
Gynecomastia

Question 17

Treatment for hyperprolactinemia

Answer 17

Dopamine D2 receptor agonist

• Bromocriptine
• Cabergoline
• Inhibit prolactin secretion
• Reduction in size of prolactin-producing adenoma

Question 18

Cabergoline

Answer 18

Dopamine D2 agonist

For hyperprolactinemia, hypersecretion of growth hormone

Question 19

Bromocriptine

Answer 19

Dopamine D2 agonist

For hyperprolactinemia, hypersecretion of growth hormone

Question 20

Side effects of bromocriptine / cabergoline

Answer 20

1. Postural hypotension 
(D1 receptor, vasodilation)
2. Constipation (decrease gut motility)
3. Nausea and vomiting 
(D2 receptors, chemoreceptor trigger zone --> vomiting centre in medulla)
4. Dizziness

Question 21

Octreotide

Answer 21

Somatostatin analogue for hypersecretion of GH

1. Inhibit release of GH from anterior pituitary
2. (minority) Reduce tumour size (reduce blood loss during surgery)

Question 22

Lanreotide

Answer 22

Somatostatin analogue for hypersecretion of GH

1. Inhibit release of GH from anterior pituitary
2. (minority) Reduce tumour size (reduce blood loss during surgery)

Question 23

Octreotide vs Lanreotide

Answer 23

Both somatostatin analogue

Octreotide:

• longer acting
• less hyperglycemic effect

Question 24

Side effects of octreotide

Answer 24

1. GI disturbance: Nausea and vomiting, Abdominal cramps, Flatulence, Steatorrhoea
2. Gall stone: ↓ gall bladder motility
3. Glucose intolerance: inhibit secretion of insulin from pancreas

Question 25

Side effects of Lanreotide

Answer 25

1. GI disturbance: Nausea and vomiting, Abdominal cramps, Flatulence, Steatorrhoea 2. Gall stone: ↓ gall bladder motility 3. Glucose intolerance: inhibit secretion of insulin from pancreas

Question 26

Pegvisomant

Answer 26

GH receptor antagonist 1. Block GH signaling 2. Inhibit hepatic production of IGF-1

Question 27

Side effects of Pegvisomant

Answer 27

1. Elevated liver enzyme 2. Nausea 3. Diarrhoea

Question 28

Treat acromegaly / gigantism

Answer 28

1. Somatostatin analogue Octreotide Lanreotide 2. GH receptor antagonist Pegvisomant 3. Dopamine receptor agonist Bromocriptine Cabergoline

Question 29

Metyrapone

Answer 29

Treat Cushing's Syndrome Inhibit 11-beta-hydroxylase

Question 30

Trilostane

Answer 30

For Cushing's Syndrome Inhibit 3-beta-drhydrogenase (3-beta-HSD)

Question 31

Side effects of metyrapone

Answer 31

1. Hypotension 2. Nausea, vomiting 3. Headache, dizziness 4. Rash

Question 32

Side effects of trilostane

Answer 32

1. Hypotension 2. Nausea, vomiting 3. Headache, dizziness 4. Rash

Question 33

Treat Cushing's Syndrome

Answer 33

Metyropone | Trilostane

Question 34

Treat diabetes insipidus

Answer 34

Vasopressin | Desmopressin

Question 35

MoA of desmopressin

Answer 35

Agonist of V2R at distal tubule and collecting ducts in kidneys - Increase aquaporin-2 transcription - Increase AQP-2 translocation to cell surface

Question 36

Side effects of desmopressin

Answer 36

1. Fluid retention 2. Dilutional hyponatremia 3. Headache 4. Nausea 5. Allergy

Question 37

Side effects of vasopressin

Answer 37

1. Fluid retention 2. Dilutional hyponatremia 3. Headache 4. Nausea 5. Allergy Only to vasopressin (less sensitive, bind to V1R…) 6. Coronary artery spasm --> angina 7. Abdominal and uterine cramps

Question 38

Treat pituitary dwarfism

Answer 38

Somatotropin

Question 39

Treat gonadotropin deficiency

Answer 39

FSH + LH replacement FSH: - Follitropin - Human menopausal gonadotropin LH: - Lutropin alpha - Choriogondadotropin alpha - HCG