Hormone replacements

Question 1

What drug + how much to give in

-adrenal crisis

Answer 1

Hydrocortisone
100mg

IM/IV

Question 2

What drug + how much to give in

-hypothyroidism

Answer 2

Levothyroxine

50-100milligrams

OD

Question 3

What drug + how much to give in

-growth hormone deficiency

Answer 3

Somatropin
45-50milligrams/kg

OD

Question 4

What drug + how much to give in

-ovarian dysfunction

Answer 4

Clomifene citrate
50 mg

OD

don’t use for longer than 6 cycles

Question 5

Contraindications for using hormones to treat ovarian dysfunction

Answer 5

1. Ovarian cysts

2. Abnormal uterine bleeding of unknown cause

Question 6

Contraindications for giving testosterone

Answer 6

1. Breast cancer in males
2. History of liver tumours
3. Hypercalcaemia
4. Prostate cancer

Question 7

What drug + how much to give in

-Diabetes insipidus

Answer 7

Desmopressin

Question 8

What drugs + how much to give in

-Addison’s

Answer 8

1. Hydrocortisone/ prednisolone
   20-30mg daily
   in 2 divided doses
2. Fludrocortisone
   50-300micrograms OD

Question 9

What drug + how much to give in

-Cushing’s

(+MoA of drug)

Answer 9

Metyrapone
750mg every 4h, 6 doses a day

Competitive inhibitor of 11-beta hydroxylation. Inhibits cortisol

Question 10

How to tell if someone with Addison’s has sufficient fludrocortisone

Answer 10

Check their placement renin.

If renin is high, suggests insufficient fludrocortisone

Question 11

Why for hormone replacement, Primary hypoadrenalism (Addison’s) requires cortisol + aldosterone

but Secondary hypoadrenalism requires cortisol only

Answer 11

In Addison’s:
Primary adrenal failure so no hormones get made

In Secondary hypoadrenalism:
there is low ACTH but normal renin.
Low ACTH = no stimulus to make cortisol
Aldosterone is produced by renin-angiotensin axis, so will continue to be produced.

Question 12

Where are the following hormones made

• renin
• angiotensin
• aldosterone

Answer 12

Renin: kidney

Angiotensin:
Angiotensinogen made in liver, converted by ACE to angiotensin in lungs

Aldosterone: adrenals

Question 13

HRT for women without uterus

Answer 13

E only
(transdermal, oral, intra-vaginal)

Question 14

HRT for women with uterus, within <1 year of LMP (perimenopausal)

Answer 14

E + P (not everyday)

• E everyday
• P every 10-14 days OR 4x a year

Question 15

HRT for women with uterus, >1 year of LMP (postmenopausal)

Answer 15

E + P everyday

Question 16

Side effects of HRT

Answer 16

• unscheduled vaginal bleeding
• increased risk of cardiovascular disease (only increased for E+P pill, not E only pill)
• increased stroke, DVT/VTE risk
• increased risk breast Ca (only for E+P. Risk increases during tx duration, risk reduced after stopping HRT)