Hypothalamus and Pituitary Flashcards
Name the drug class and examples that are used to treat hyperprolactinemia
Dopamine agonists
ex. Bromocriptine, cabergoline
Levels twice the upper limit of Insulin-like growth factor suggest what disease?
Acromegaly
Who is GH treatment generally recommended for?
- “idiopathic short stature”
- Height more than 2.25 standard deviations below mean for age
- GH provacative testing
Somatropin: genotropin, growth hormone treatment regulates what?
- lipid and carbohydrate metabolism
- builds lean body mass
- regulates insulin-like growth factor 1 production in peripheral tissues
Somatropin indications
-Short stature (ex. Turner syndrome, Prader-Willi syndrome)
- Failuire to Thrive
- Small for gestastional age
- Idiopathic short stature (may add 1.5-3 inches
Name 3 indications for GH in adults
- Growth hormone deficiency
- Wasting in HIV patients
- Short bowel syndrome
Somatropin ADEs in children
- Pseudotumor cerebri (increased intracranial hypertension)
- Slipped capital femoral epiphysis
- Progression of scoliosis
- Hyperglycemia
Somatropin drug interactions
- Glucocorticoids - may inhibit growth promoting effects
- Use with other hormones may accelerate epiphyseal closure and compromise final height (ex. androgens, thyroid hormones)
Mecasermin (recombinant IGF-1) use
If not growing and unresponsive to GH therapy + IGF-1 deficiency
Mecasermin (recombinant IGF-1) ADEs
- Hypoglycemia (eat snack/meal before dose!)
- Tonsillar/adenoidal hypertrophy. Lymphoid hypertrophy
- Coarsening facial features
Treatment of choice for acromegaly
transsphenoidal microsurgery
Acromegaly in adults
Gigantism in children/adolescents
How is glucose used to determine GH disease?
oral glucose tolerance test (OGTT) - give large dose of glucose orally and expect GH to be supressed….if they continue to secrete GH there’s a problem (ex. acromegaly)
GH excess: pharmacologic treatment
- Dopamine agonists (cheap, low cost, only works for some)
- Somatostatin analogs (more effective than Dopamine agonists)
- Pegvisomant (GH-receptor antagonist) - very helpful in normalizing IGF-1
Dopamine agonists in Acromegaly
- Cause a paradoxical decrease in GH
- normalize IGF-1 (cabergoline > Bromocriptine)
Dopamine agonists for acromegaly: ADEs
Respiratory: thickening of bronchial secretions and nasal congestion**
Somatostatin analogs (GH antagonists) examples and ADEs
Ex. Octreotide, Lanreotide, Pasireotide
- Gallstones
- Cardiac conduction abnormalities
- HTN
- Abnormalities of glucose metabolism
- Subclinical hypothyroidism
Pegvisomant (GH antagonist) MOA
- inhibits IGF-1 production
- Blocks the physiologic effects of GH on target tissues
Pegvisomant (GH antagonist) ADE
Increased liver enzymes (AST, ALT)
When to use Pegvisomant?
only if other treatments have failed
Selective estrogen receptor modulator (SERM) examples
Raloxifene and Tamoxifen
- can be useful in postmenopausal women, or those who have had breast cancer
- serum testosterone levels increase in men
What is an appropriate medication for most GH patients?
somatostatin analog
What is the most appropriate treatment in mild GH?
Dopamine agonist
Which drugs can cause hyperprolactinemia because they are dopamine antagonists?
Antipsychotics*
Prolactin stimulating drugs
- Methyldopa
- Reserpine
- Benzodiazepines
- SSRIs
- H2 receptor blockers
- Opioids
- Cocaine
Which type of drug is typically more successful than surgery in hyperprolactinemia?
Dopamine agonists
Transsphenioidal surgery for hyperprolactinemia: indications
- reserved if patient is refractory to therapy or can’t tolerate dopamine agonists
- Large tumors that are compressing adjacent tissues
D2-receptor agonists: which is most effective and considered 1st line
Cabergoline is more effective than Bromocriptine
Which dopamine agonist is probably the best to start with for a patient with prolactinoma and wishes to become pregnant?
Bromocriptine
Cabergoline: ADE
Decreased blood pressure (mild/moderate)
-nasal congestion
Bromocriptine ADE
nausea
