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(Duluth) HRM Final Review > Hellekant Pituitary > Flashcards

Hellekant Pituitary Flashcards

1
Q

Growth hormone is produced by what cells?

A

Somatotrophs

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2
Q

Prolactin is produced by what type of cells?

A

Mammotrophs

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3
Q

What hormones are produced by acidophils?

A

Growth hormone and prolactin

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4
Q

What effect does TRH have on prolactin?

A

Promotes release of prolactin

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5
Q

What effect does somatostatin have on growth hormone?

A

Inhibition

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6
Q

What effect does dopamine have on Growth hormone?

A

Inhibits GH release

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7
Q

What kind of receptor is GHRH receptor?

A

GPCR - stimulate adenylyl cyclase

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8
Q

What type of receptor are the somatostatin receptors?

A

Gi

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9
Q

What type of receptor are the GH receptors?

A

Transmembrane on target cells - activate JAK/STAT

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10
Q

When growth hormone acts on the liver, what happens?

A

The liver produces insulin-like growth factor - 1

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11
Q

What are the actions of growth hormone?

A

Promotes muscle mass and longitudinal (linear) bone growth, can cause hyperglycemia, increases mobilization of fats; acts on liver to increase release of IGF-1

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12
Q

How is the growth hormone receptor binding protein produced?

A

Proteolysis of GHR at the cell surface; thereby releasing its extracellular domain

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13
Q

What effects does IGF-1 have?

A

Increases cartilage growth

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14
Q

Severe GH deficiency in children leads to what?

A

Proportional dwarfism

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15
Q

What is the pathogenesis behind proportional dwarfism?

A

Severe GH deficiency

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16
Q

What is Laron syndrome?

A

AR GHR variant with insensitivy to GH; imparts resistance to CA and DM and prolongs life

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17
Q

What condition is caused by gene mutation in the GH receptor, resulting in insensitivity to GH?

A

Laron syndrome

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18
Q

What are the symptoms of GH def in adults?

A

Generalized obesity, reduced muscle mass, asthenia, reduced cardiac output

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19
Q

What does the insulin tolerance test tell you?

A

Give insulin, create hypoglycemia, and should see increased cortisol from the adrenals, and increased GH from anterior pituitary; failure to respond may suggest need for GH or glucocorticoids

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20
Q

What is sermorelin?

A

GHRH analog

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21
Q

What tests can be used to assess GH deficiency?

A

Insulin tolerance test or GHRH analog and arginine co-stimulation test

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22
Q

How is the arginine GHRH test done?

A

Inject arginine over 30 minutes, inject GHRH over 1 minute, measure serum GH over the next hour; should see GH > 8, if less suggests GH def

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23
Q

What is the mot common pituitary hormone deficiency in children?

A

Growth hormone

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24
Q

What is an early sign of GH deficiency in children?

A

Hypoglycemia - due to unopposed action of insulin

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25
Q

What are the therapeutic uses of GH in adults?

A

GH def, wasting in patients with HIV, short bowel syndrome

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26
Q

Why is GH used in short bowel syndrome in patients receiving specialized nutrition support?

A

Improved mucousal integrity and thus GI function

27
Q

What is somatropin?

A

Recombinant human growth hormone

28
Q

When using rhGH in adults, what labs should be monitored?

A

Lipid profile, fasting glucose, bone density

29
Q

In Laron-type dwarfism, low levels of what are seen?

A

IGF-1; GH does not have effect on GHR on liver

30
Q

What is mecasermin?

A

Aka increlex = rh IGF-1

31
Q

What is mecasermin rinfabate?

A

Complex of rhIGF-1 + IGFBP3

32
Q

What is Iplex?

A

Mecasermin rinfabate - complex of rhIGF-1 + IGFBP3

33
Q

What are the drug names for rhIGF?

A

Mecasermin (increlex) or mecasermin rinfabate (iplex)

34
Q

What is IGFBP3?

A

IGF carrier protein

35
Q

When should rhIGF be avoided?

A

Children with cancer; in patients with closed epiphyses

36
Q

Hypersecretion of GH in adults is most commonly due to what?

A

GH secreting anterior pituitary adenoma

37
Q

Abnormal growth of what tissues is seen in hypersecretion of GH?

A

Abnormal growth of cartilage, bone, skin, muscle, heart, liver, GI

38
Q

What is usually first indication of GH hypersecretion?

A

Elevated IGF-1

39
Q

How is GH hypersecretion confirmed?

A

Elevated GH level 2 hours after glucose administration

40
Q

During sleep, how does a patient with acromegaly differ from a “normal” patient?

A

GH levels do not show circadian rhythm or peaks and nadirs, but are within normal range

41
Q

How is GH hypersecretion treated?

A

GH inhibitory hormones: somatostatin and dopamine

42
Q

What dopamine receptor is targeted in treatment of GH adenoma?

A

D2

43
Q

What is octreotide?

A

Somatostatin analog (long acting)

44
Q

What is pegvisomant?

A

PEG derivative of mutant GH; binds GH receptor and blocks downstream events

45
Q

What is one of the problems encountered when using pegvisomant?

A

Blocks GHR on liver, decreasing IGF-1 release, but then increasing GH secretion due to loss of negative feedback

46
Q

What drug is a GH antagonist?

A

Pegvisomant

47
Q

What dopamine analogs are used in the treatment of pituitary adenoma that is secreting prolactin/growth hormone?

A

Bromocriptine and cabergoline

48
Q

What is the MOA of bromocriptine?

A

Dopamine analog at D2 receptor

49
Q

What is the MOA of cabergoline?

A

Dopamine analog at D2

50
Q

What effect does VIP have on prolactin?

A

Promotes release

51
Q

What effect does TRH have on prolactin?

A

Promotes release

52
Q

What is the primary inhibitor of prolactin release?

A

Dopamine

53
Q

What do mammotrophs produce?

A

Prolactin

54
Q

What type of receptor does prolactin bind?

A

Transmembrane proteins that activate JAK/STAT family; tyrosine kinase

55
Q

What form of the prolactin receptor is the active form?

A

Long form

56
Q

What form of the prolactin receptor is acts as a dominant negative form?

A

Short form

57
Q

What are the physiologic effects of prolactin?

A

Breast development during pregnancy, milk secretion during lactation

58
Q

What effect does prolactin have on breast tissue?

A

Expansion of lobular-alveolar development during pregnancy

59
Q

During pregnancy, what is inhibiting lactation?

A

High levels of progesterone

60
Q

Hypersecretion of prolactin in males results in what?

A

Impotence

61
Q

Hypersecretion of prolactin has what effects on hormones?

A

Inhibits GnRH, and therefore decreases gonadal hormones

62
Q

What is the preferred treatment of prolactinoma?

A

Cabergoline - dopamine agonist; high efficacy

63
Q

What receptors are targeted in treatment of prolactinoma?

A

D2

(Duluth) HRM Final Review (22 decks)

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