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Summer Pharm Exam 1 > Hypothalamus & Pituitary > Flashcards

Hypothalamus & Pituitary Flashcards

1
Q

What hormones does the anterior pituitary release

A 
FSH, LH, ACTH, TSH, PRL, GH
Those hormones (EXCEPT PRL) go on to stimulate production of hormones from peripheral endocrine glands, liver, or other tissues
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2
Q

What hormones does the posterior pituitary release

A 
Oxytocin, ADH/vasopressin 
Those hormones (along with PRL) act directly on tissues
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3
Q

What hormones are released from the hypothalamus and what are their funcitons

A
  • GHRH: rarely used as GH/GHRH sufficiency test
  • TRH: can dx TRH/TSH deficiency
  • CRH: rarely used to dx Cushing
  • GnRH: treats infertility caused by deficiency, stops gonad fxn in precocious puberty, men w/ prostate cancer, women undergoing ART, and ovarian suppression for women w/ gyno d/o
  • Dopamine: Tx hyperprolactinemia
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4
Q

What is Growth Hormone’s primary target organ hormone

A

IGF-1

target organs are liver, bone, muscle, kidney, etc.

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5
Q

What provocative pharm GH stimulation tests can you do for GH deficiency

A 
Insulin induced hypoglycemia 
Clonidine 
L-dopa
Arginine 
Glucagon
GHRH 
-You expect GH to increase. If GH increases <10 in 2 hours, you have a GH deficiency
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6
Q

What will you likely see along with GH deficiency

A

reduced IGF-1
hypoglycemia
hypothyroidism
loss of other pituitary hormones

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7
Q

Who should get GH treatment

A

kids with idiopathic short stature (<2.25 SD below mean height for age)
subnormal growth for age
delayed bone age
low serum IGF-1
*>50% of kids with GH deficiency secrete normal GH and IGF1 as adults

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8
Q

What are treatments for GH deficiency

A

Somatotropin (Genotropin)
Mecasermin (Increlex)
*Needed for normal growth to regulate lipid and carb metabolism and LBM ; also to regulate production of IGF-1 in peripheral tissues
-CAN switch formulations during Tx w/o negative impacting growth trajectory

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9
Q

Child indications for GH treatment

A

Short stature (turner, Noonan, or Prader-Willi syndrome)
FTT (2/2 chronic renal failure)
small for gestational age
*Will only add appx 1.5-3 inches if w/ idiopathic short stature

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10
Q

Indications for GH treatment in adulthood

A

GH deficiency (will improve metabolism, LBM, and well being)
Wasting 2/2 HIV (increase LBM, weight, endurance)
Short bowel syndrome (improve GI fxn)

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11
Q

ADE of Somatotropin (genotropin)

A

Kids: pseudotumor cerebri (HA, blurred vision, diplopia, n/v), slipped capital femoral epiphysis, scoliosis progression, hyperglycemia
Adults: rarely peripheral edema, myalgia, arthralgia

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12
Q

If a child is taking Somatotropin (genotropin) always monitor

A

concurrent deficiency of other ant pit hormones

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13
Q

Drug interactions when taking Somatotropin (genotropin) include

A

glucocorticoids (inhibit growth promoting effects)
Other hormones; androgens, estrogens, thyroid hormones, anabolic steroids (speed up epiphyseal closure, compromising final height)

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14
Q

What is Mecasermin

A

Recombinant human IGF-1 for kids with growth failure that DON’T respond to GH therapy and are deficient in IGF-1

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15
Q

ADE of Mecasermin include

A

Hypoglycemia (eat before taking dose!)
Tonsillar/adenoidal hypertrophy
Lymphoid hypertrophy
Coarse facial features

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16
Q

GH secreting pituitary adenomas cause

A

Acromegaly in adults

Gigantism in kids and teens

17
Q

TOC for acromegaly is

A

Pituitary transsphenoidal microsurgery

18
Q

What diagnostic test is preferred for excess GH

A

OGTT;
postprandial hyperglycemia inhibits secretion of GH for 1-2 hours
if you give an oral glucose load, GH should decrease

19
Q

Secondary testing for GH excess is

A

Serum IGF; GH stimulates IGF-1 production

20
Q

What pharm treatment options are available for GH excess

A 
Dopamine agonists (bromocriptine, cabergoline) 
Somatostatin analogs (Octreotide, Lanreotide, Pasireotide)- more effective than dop. ag
GH receptor antagonist (Pegvisomant)
21
Q

Pegvisomant is highly effective at

A

normalizing IGF-1 in 97% in one year, 60% in 5 years

22
Q

Dopamine agonists are used mainly to treat

A

Acromegaly;
they normally cause an increase in GH production. In Acromegaly, they cause a paradoxical DECREASE in GH production
*They also normalize IGF-1 concentrations (cabergoline>bromocriptine)
*Cabergoline can be added to a somatostatin analog

23
Q

ADE of Dopamine Agonists are

A

CNS: HA, light headed, dizziness, nervous, fatigue
GI: nausea, abd pain, diarrhea
Resp: nasal congestion, thick bronchial secretions

24
Q

How do somatostatin analogs (octreotide) work

A

inhibit release of GH, glucagon, insulin, and gastrin
Tx acromegaly and other neuroendocrine tumors
*long acting forms available; 4-6 wk duration

25
Q

ADE of Somatostatin analogs (octreotide) are

A

gallstones (inhibit release of CCK)
cardiac conduction abn
HTN
Abnormalities in glucose metabolism (decrease insulin, inhibits IGF-1)
Subclinical hypothyroid (TSH high, T4 normal)

26
Q

How does Pegvisomant work

A

Inhibits IGF-1 production
blocks physiologic effect of GH on tissues
Treats acromegaly in pts who failed to achieve normal IGF-1 with other Tx

27
Q

ADE of Pegvisomant include

A

Increased liver enzymes
edema
nausea
diarrhea

28
Q

What are Raloxifene and Tamoxifen used for

A

Selective estrogen receptor modulators
Treat persistent acromegaly in men and post-menopausal women with Hx of breast cancer
Reduces and normalizes IGF-1 levels (does not reduce GH)
*Serum testosterone in men increases

29
Q

What are prolactinomas

A

benign prolactin secreting pituitary tumors

30
Q

What can cause hyperprolactinemia

A

Prolactinomas or Medications (increase PRL or antagonize Dopamine)

31
Q

What are some drugs that cause hyperprolactinemia

A

Increase PRL: methyldopa, reserpine; estrogen, benzos, TCA, MAOI, SSRI, opioids, cocaine
Dopamine antag: antipsychotics, phenothiazine, metoclopramide
Verapamil

32
Q

How do you treat hyperprolactinemia

A 
#1: Dopamine agonist (better than surgery!) 
Radiation therapy (W/ surgery to shrink tumor and decrease PRL) 
TSS (if refractory or cant tolerate meds; if very large tumor)
33
Q

What are the dopamine agonists

A

Cabergoline (pref), bromocriptine

Inhibit release of PRL (Dop inhibits PRL)

34
Q

ADE of bromocriptine are

A

Infertility! HA, dizzy, fatigue, diarrhea, nausea, abd pain

give with food

35
Q

ADE of cabergoline are

A

decrease in BP; constipation, n/v, fatigue, anxiety, depression
(rare) HA, dizzy

36
Q

What is Panhypopituitarism

A

complete (or partial) loss of pituitary fxn; involves ant and post pit
-ACTH/ Gonadotropin/ GH deficiency, hypothyroidism, hyperprolactinemia

37
Q

How do you treat panhypopituitarism

A

Replace glucocorticoids, thyroid hormones, and sex steroids
+/- recombinant GH
**Tx is lifelong w/ constant monitoring!

Summer Pharm Exam 1 (8 decks)

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