Hypothalamus and Pituitary therapy Flashcards
except for prolactin, hormones released from the ____ pituitary stimulate production of hormones by a _____
anterior
peripheral endocrine gland, liver, or other tissues
which hormones act directly on target tissues?
posterior pituitary hormones (vasopressin & oxytocin)
prolactin
which factors regulate the release of anterior pituitary hormones?
hypothalamic factors
Hypothalamic hormones: GnRH clinical uses
treat infertility
LA forms: precocious puberty, transgender/gender variant, men w/prostate CA and women undergoing assisted reproductive tecnology (ART)
Hypothalamic hormones: Dopamine clinical uses
tx of hyperprolactinemia
Growth hormone (GH, -somatotropin): describe the link between hypothalamic hormone, target organ, primary target organ hormone or mediator
hypothalamic hormone = GHRH (+) & Somatostatin (-)
liver, bone, muscle, kidney, others
insulin-like growth factor-I (IGF-I)
GH or somatotropin physiology
direct anti-insulin effects on lipid and carbohydrate metabolism
stimulates gluconeogenesis in hepatocytes, impaires tissue glucose uptake, decr’s insulin-receptor sensitivity, impairs postreceptor insulin action
stimulates formation of IGF-1 in the liver and peripheral tissues
lowest during infancy, peak during adolescence, decline during middle-age years
Growth hormone deficiency agonists?
somatropin
mecasermin
What lab studies detect GH deficiency?
no gold standard for dx exists
give provocative pharmacologic GH stimuli: insulin-induced hypoglycemia, clonidine, L-dopa, arginine, glucagon, GHRH
subnormal GH response during childhood = peak GH serum concentration less than 10ug/L
Who is tx for GH deficiency recommended for?
children who have “idiopathic short stature” and pass GH provocative testing +
height >2.25 SD’s below mean for age, subnormal growth velocity, delayed bone age, low serum IGF-1, etc…
GH tx’s
Somatotropin: Genotropin
Mecasermin: increlex
Why do we need GH?
required for normal growth
regulates lipid and carbohydrate metabolism and lean body mass
regulates production in peripheral tissues of insulin-like growth factor 1 (IGF-1)
What is the recombinant form of Human GH?
somatropin
Indications for somatropin?
short stature (Turner’s, Noonan’s, Prader-Willi syndromes)
failure to thrive
small-for-gestational age
controversial use: children w/idiopathic short stature (may add 1.5-3in)
What are the GH products on the market?
Genotropin Humatrope Norditropin Nutropin AQ Omnitrope Saizen Serostim Zomactin Zorbtive
What is the primary therapeutic objective in an adult with GH deficiency?
improved metabolic state, increased lean body mass, sense of well-being
What is the primary therapeutic objective in an adult with wasting in pt’s with HIV?
increased lean body mass, weight, physical endurance
What is the primary therapeutic objective in an adult with short bowel syndrome?
improved GI fx
Somatropin ADE’s in children
pseudotumor cerebri
slipped capital femoral epiphysis
progression of scoliosis
hypergylcemia
*monitor in children for concurrent deficiency of other ant. pituitary hormones
Somatropin ADE’s in adults
generally tolerated
peripheral edema
myalgia
arthralgia
Drug interactions of somatropin?
glucocorticoids - may inhibit growth-promoting effects of recombinant GH
concomitant administration of other hormones - accelerate epiphyseal closure and compromise final height
Mecasermin
recombinant human IGF-1 (insulin like growth factor 1)
Who should you tx w/ Mecasermin?
children w/growth failure unresponsive to GH therapy and deficiency in IGF-1
ADE’s of Mecasermin?
hypoglycemia - consumption of a snack or meal shortly before dose
tonsillar/adenoidal hypertrophy, lymphoid hypertrophy
coarsening facial features
anaphylaxis and arthralgia
