Gonadal Hormones Flashcards
GnRH secretion is
pulsatile & periodic in order to be stimulatory
When to LH hormones (gnrh sections) lenthen
During sleep
WHich chromosome is GnRH on
8
GnRH is what type of hormone
How many peptides in final form
Peptie
92 propetide
10 active form
GnRH admistation
IM
Nasal
Clincal Use
Suppression of estrogen production in hormone-dependent breast or prostate cancer
Delay the onset of precocious puberty
Delay puberty in transgendered youth who are too young for hormone-replacement therapy
Hypergonadism: Disrupts the GnRH pulse generator.
What is a tumor flare
How is it managedj
- Bolus release caues initial LH & FSH
managed by estrogen or androgen antagonists.
Side effects of GnRH in males
Increased risk of diabetes, MI, sudden cardiac death, stroke; monitor blood glucose and for signs/symptoms of CVD during therapy.
Co-symptomatic with androgen suppression/Low Testosterone.
Risk of ureteral obstruction or spinal cord compression (monitor during 1st month of therapy).
Side effects of GnRH in females
Non-diagnosed abnormal vaginal bleeding: not recommended.
Risk factors for decreased bone mineral density (e.g. chronic alcohol, tobacco, anticonvulsants, corticosteroids).
Premenopausal women: use nonhormonal contraception during and for 12 weeks after therapy or until menses resume.
Nursing mothers: not recommended.
Estrongen
Uses
Uses
- Contracption
- HRT
- Oncology (anti-estrogens>estrogens)
- Male to female transger promotion
Tamofen
Mechanism
Use
Mechanism
- Selective estrogen antagonist
- Non-stimulatoryu in breat but stimulatory in uterus = uterine cancer
Use
- Reduce risk of breast cancer recurrence
Arimidex
Mechanism
Use
Mechanism
- Blocks conversion of testerone to estradiol
- Causes decrease in estrogen and increase in testosterone
Use
- Reduce risk for breast cancer
Estrogen contradictions
Pregnancy
Lactation
Breast cancer
Personal breast cancer history
Familial breast cancer history
In post-menopausal women HRT can increase the risk of ovarian cancer, breast cancer, stroke, dementia, blood clots.
All of these risks are greater in smokers.
Anti-estrogen contraindications
Pregnancy
Lactation
Uterine Cancer
Personal uterine cancer history
Progesterone
Use (2)
Contradications
Use
- Support pregnancy where there is a high risk of miscarriage.
- Counteract the thickening of the uterine lining caused by post-menopausal estrogen
Contraindications
- Depression
- Migraines
- Tobacco use
- Clotting disorders
- Siezures
- SLE
- Breast Cancer
- Ovarian Cancer
Mifepristone
Mechanism
Use
Contraindications
Mechanism
- Anti-progesterones
Use
- “Morning after pill”
- Post-coital contraceptive
Interferes with progesterone signalingendometrial thickening and implantation - Abortifacient
Sufficient to cause miscarriage of implanted embryo in 1st trimester
Contraindications
- IUD
- Ectopic Pregnancy
- Adrenal failure
- Hemorrhagic disorders
- Porphyria
- Prolonged anti-coagulant use
- Prolonged corticosteroid use
WHat is ADAM
Treatment?
Androgen Deficiency in Aging Men
ART be considered (unless otherwise contra-indicated) when total serum testosterone is < 200ng/dL (6.9nM)
Mechanism of admistration
Testerone esters
Alkylated testerone
Transdermal systems
Testerone esters - pareneterally
Alkylated testerone- Oral active & liver toxixity
Transdermal systems
Androgen Replacement
Use
Androgen Defiency
- hypopituitarism and hypogonadism
- ADAM (aka andropause)
- Female to male transgender promotion
Gynecologic Disorders
- Post-partum breast engorgement
- Endometriosis
= Chemotherapy in ER-positive Breast tumors in pre-menopausal women (very rarely used)
- Anemia
- Osteoporosis
- Growth stimulation (delayed puberty in males)
- Anabolic abuse in sports
- Mammery hyperplasia & breast cancer
Arimidex
Mechanism
Aromatase inhibitors (e.g. Arimidex) not only block estrogen production but also enhance androgen levels
Contraindications of androgen enhancement
Pregancy CDV defect Prostate cancer or BPH Hepatic disease Hypercalcemia Renal disease Soya lecithin hypersensitivity Tartrazine dye hypersensitivity
Finasterdine
Mechamism
Use
No effect on
SE
Mechanism
5 Reductase Inhibitor
Use
benign prostatic hyperplasia (Proscar, Avodart) and male patterned baldness (Propecia).
NOT EFFECTIVE AGAINST PROSTATE CANCER, HPA axis
Dose
Oral
SE
- Decreased libido
- Impotense
Only 5 Reductase Inhibitor withought decreased impotence or libido
Tamsulosis
6 SE of andorgen enhancement
Masculinization of women and pre-pubertal children
Disruption of CNS development in early life
Alkyl-substituted Androgens are associated with hepatic dysfunction
Associated with increased water-retention and edema
Androgens like other steroids will increase the expression and activity of the Cyp enzymes, particularly in the liver. This may in turn increase the metabolism of other drugs, thereby decreasing their efficacy.
Increased risk of prostatic hyperplasia and prostate cancer.
4 Adverse effects of Anti-androgen Therapy
ppression of gonadal function, loss of libido.
Disruption of male pubertal development.
Elevated hepatic enzymes, hepatic failure
Hyperplasia of mammary epithelia.
Androgens have been used successfully against estrogen-dependent breast cancers, but are rarely used currently because of negative side-effects such as masculinization, hirsuitism etc.
4 contraindictaions effects of Anti-androgen Therapy
Contraindicated in women who are pregnant or who may become pregnant.
Contraindicated in male patients with carcinoma of the prostate or breast.
Special caution when using androgens to generate a growth spurt.
Androgen therapy has been associated with hepato-cellular carcinoma.
Estrogen can reduce symptoms of which neurological disorder
MS!
