Hypothalamus

Question 1

May be used in pulses to treat infertility caused by GnRH deficiency

Answer 1

Gonadotropin-releasing hormone (GnRH)

Question 2

What can dopamine agonists tx?

Answer 2

hyperprolactinemia

Question 3

Regulates IGF production in peripheral tissues

What drugs?

Answer 3

somatropin

mescasermin

Question 4

Children indications of somatotropin

Answer 4

Short stature:

Turner syndrome, Noonan syndrome, Prader-Willi syndrome

Failure to thrive due to chronic renal failure

–Small-for-gestational-age condition

Controversial use: children with idiopathic short stature

May add 1.5-3inches

Question 5

What 3 other clinical conditions do you use GH for?

Answer 5

GH definiciency in adults

wasting in HIV ps

short bowel syndrome

Question 6

somatropin ADEs in children

Answer 6

Pseudotumor cerebri

slipped capital femoral epiphysis

scoliosis

hyperglycemia

Question 7

somatropin drug interactions

Answer 7

glucocorticoids

concomitant admin of other hormones

Question 8

what happens if you administer other hormones with somatropin?

(androgens, estrogens, thyroid hormones, anabolic steroids)

Answer 8

accelerate epiphyseal closure and compromise final height

Question 9

Recombinant human IGF-1 (insulin like growth factor 1)

administered parenterally

which drug?

Answer 9

mecasermin

Question 10

indications of mecasermin

Answer 10

children with growth failure unresponsive to GH therapy are deficient in IGF-1

Question 11

ADEs of mecasermin

Answer 11

Hypoglycemia

Tonsillar/adenoidal hypertrophy, lymphoid hypertrophy

Coarsening facial features

Question 12

What should you take mecasermin with and why?

Answer 12

a snack to prevent hypoglycemia

Question 13

What two conditions does growth hormone-secreting pituitary adenomas cause?

Answer 13

acromegaly

gigantism

Question 14

What is the main diagnostic tool for acromegaly?

Answer 14

OGTT

Question 15

describe OGTT effects on body that leads to a + acromegaly dx

Answer 15

inc. OGTT –> inc. GH –> inc. IGF-1

in normal pts: OGTT should dec. GH

Question 16

what are the dopamine agonists

Answer 16

bromociptine and cabergoline

Question 17

normalize IGF-1 concentrations –> paradoxical decrease in GH production

which drug

Answer 17

dopamine agonists (bromocriptine, cabergoline)

Question 18

Main ADE of dopamine agonists (bromocriptine, cabergoline)

Answer 18

thickening of bronchial secretions and nasal congestion

Question 19

somatostatin analogs

Answer 19

Octreotide, Lanreotide and Pasireo_tide_

Question 20

inhibit the release of : GH, glucagon, insulin, and gastrin

which drug?

Answer 20

somatostatin analogs (-tides)

Question 21

uses of somatostatin analogs (-tides)

Answer 21

treat acromegaly

other neuroendocrine tumors

Question 22

ADEs of somatostatin analogs (-tides)

Answer 22

Gallstones

Cardiac conduction abnormalities

Hypertension

Abnormalities in glucose metabolism

Subclinical hypothyroidism

Question 23

Inhibits IGF-1 production

Blocks the physiologic effects of GH on target tissues

which drug?

Answer 23

Pegvisomant

Question 24

use of pegvisomant

Answer 24

Acromegaly in patients who have failed to achieve normalization of IGF-1 serum concentrations with other treatments

Question 25

main ADE of pegvisomant

Answer 25

inc. liver enzymes

Question 26

Selective estrogen receptor modulator (SERM)

Answer 26

raloxifene tamoxifen

Question 27

use of SERM (raloxifene & tamoxifen)

Answer 27

persistent acromegaly in men and in women who are **postmenopausal or who have had breast cancer**

Question 28

T/F: Estrogens more potent in IGF-1 reduction than are SERMS

Answer 28

TRUE

Question 29

tx algorithm for acromegaly

Answer 29

1. somatostatin analogs 2. Dopamine agonists 3. Pegvisomant

Question 30

what is a prolacinoma

Answer 30

Benign prolactin-secreting pituitary tumors

Question 31

Hyperprplactinemia tx

Answer 31

dopamine agonists (more effective than surgery) transsphenoidal surg + radiation (for pts refractory to or cannot tolerate therapy with DA)

Question 32

Hypothalamic release of dopamine **inhibits the release of prolactin** MOA of which drug?

Answer 32

D2-recedptor agonists

Question 33

main ADE of bromocriptine

Answer 33

infertility "bros are infertile"

Question 34

main ADE for cabergoline

Answer 34

mild-mod dec.in BP

Question 35

complete or partial loss of pituitary function

Answer 35

panhypopituitarism

Question 36

tx of panhypopituitarism

Answer 36

Replacement of –**Glucocorticoids** –**Thyroid hormone preparations** –**Sex steroids** _**Will need lifelong replacement therapy and constant monitoring\*\***_