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Endocrine Two > Kruse - Hypothalamic and pituitary hormones DSA > Flashcards

Kruse - Hypothalamic and pituitary hormones DSA Flashcards

1
Q

Anterior pituitary hormones: GH and PRL - structure and receptors they activate

A

Structure - single chain proteins

Activate JAK/STAT activating kinase receptors

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2
Q

Anterior pituitary hormones: TSH FSH, and LH - structure and receptors they activate

A

Structure - dimeric proteins

Activate GPCRs

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3
Q

Anterior pituitary hormones: ACTH - structure

A

Structure - single peptide

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4
Q

What inhibits TSH and TRH production?

A

T4 and T3

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5
Q

What inhibits GSH, LH, and GnRH?

A

females - estrogen and progesterone

males - androgens

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6
Q

What inhibits ACTH and CRH?

A

Cortisol

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7
Q

What stimulates GH, what inhibits it?

A

stimulated by GHRH, inhibited by somatostatin (SST)

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8
Q

What inhibits PRL production?

A

D2 dopamine receptors predominantly under inhibitory control by this means

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9
Q

What stimulates PRL production?

A

TRH and hormones of glucagon family (VIP, GIP, secretin, glucagon). BUT release is predominantly under hypothalamic D2 inhibitory control.

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10
Q

*** GHRH(+)/somatostatin(-) (hypothalamic hormones) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

A

GH (somatotropin) –> liver, muscle, bone, kidney (IGF-1)

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11
Q

*** TRH(+) (hypothalamic hormone)—> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

A

TSH —> thyroid (T4, T3)

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12
Q

*** CRH(+) (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

A

ACTH —> Adrenal cortex (GC, MC, androgens)

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13
Q

*** GnRH (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

A

FSH and LH –> gonads (estrogen, progesterone, testosterone)

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14
Q

*** Dopamine (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

A

PRL —> breast

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15
Q

Name of recombinant form of GH

A

somatropin

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16
Q

What effect does GH have on insulin sensitivity?

What effect dos IGF-1 have on insulin sensitivity?

A

reduces it - causes mild hyperinsulinemia

GH –> JAK/STAT –> increased IGF-1 –> growth [IGF-1 increases insulin sensitivity to lower glucose]

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17
Q

A child has short stature and is given something to achieve normal height. What would treatment with this drug combat in adults with the same hormonal deficient?

A

Drug: rhGH

Adults with GH deficiency have general obesity, reduced muscle mass, asthenia, reduced CO. This GH deficiency could be due to pit or hypothalamus damage.

18
Q

Syndromes, other than GH-deficiency, that rhGH can help effect stature.

A

Turner syndrome, prader willi, noonan syndrome

19
Q

AE of a child with Turner syndrome, hypothyroid, pancreatitis, gynecomastia - taking GH

A

otitis media, scoliosis, intracranial HTN (vision change, hypothyroid, nausea, vomiting)

20
Q

An adult has peripheral edema, myalgias, arthraliga, and carpal tunnel syndrome - what are these AE SE of? And what is a CI of this same drug?

A

GH

CI - malignancy

21
Q

A child has growth failure with severe IGF-1 deficiency. He does not respond to rhGH. What complex can be given?

A

Mecasermin - recombinant human IGF-1 and recombinant insulin-like GF-binding protein3 (IGFBP3)

22
Q

What should a patient taking mescasermin be instructed to do prior to taking the drug - why?

A

eat 20 minutes before administration, to avoid hypoglycemia.

23
Q

What can be used to treat ant-pit adenomas (acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, any hormone secreting tumors, etc.) that secrete GH?

A

GH-antagonists: somatostatin (SST) analogs –> Octreotide and Lanreotide

24
Q

What SST analogs are particularly approved for tx of acromegaly?

A

Lanreotide and Pegvisomant

25
Q

A person with a hormone secreting tumor is given an SST analog. What AE should be watched for?

A
  • GI N/D/pain
  • GALLSTONES
  • cardiac effects (sinus brady, conduction disturbances)
  • B12 deficiency
26
Q

MOA of pegvisomant v. SST analogs

A

pegvisomant is a GH receptor antagonist

27
Q

A person has hyperprolactinemia (i.e. due to prolatinoma), or acromegaly or Parkinson Disease. Give what?

A

D2 Dopamine receptor agonists - bromocriptine, not cabergoline (only for hyperPRL)

28
Q

A person presents with HA, dizziness, N, fatigue, PULMONARY INFILTRATES, and possibly psychiatric manifestations. What is he/she taking?

A

Bromocriptine and cabergoline

29
Q

If a pregnant woman has a macroadenoma v. microadenoma - can she continue therapy of D2-R agonist?

A

Macroadenoma - yes, can continue.

Microadenoma - no, discontinue bc microadenoma growth during pregnancy is rare

30
Q

Why are D2 agonists not recommended to suppress postpartum lactation?

A

increased risk of stroke or coronary thrombosis.

31
Q

Peptide hormone released in response to rising plasma osmolality or falling blood pressure.

A

Vasopressin and desmopressin (ADH)

32
Q

Difference between desmopressin and vasopressin.

A 
Desmopressin = majority V2, minimal V1 activity (Kidneys)
Vasopressin = V1 (CARDIAC/vasoconstrictive effects)
33
Q

Central DI v. nephrogenic DI will respond how to vaso/desmopressin?

A

central DI will have an effective increase in urine osmolality (problem with ADH secretion) while nephrogenic will not (problem with kidneys, not ADH)

34
Q

Vasopressin’s vasoconstrictive effects means that pts with ____ should be carful when taking?

A

Coronary artery disease - due to the vasoconstriction

35
Q

A person is having seizures and hyponeatremia - this is due to what?

A

overdose of vasopressin

36
Q

A person ahs CHF or SIADH that caused euvolemin and hypervolemic hyponatremia. What drugs should be used?

A

Vasopressin antagonsists - conivaptan and tolvaptan.

They increase renal free water exretion with no change in electrolyte excretion.

37
Q

Describe differences between Tolvaptan and Conivapton MOA

A

Conivaptan - V1 and V2 (nonselective) antagonists

Tolvaptan - V2 selective antagonists

38
Q

Tolvaptan and Conivapton metabolization

A

CYP3A4

39
Q

A woman presents with amenorrhea and galactorrhea. A male presents with loss of libido and infertility. What hormone are they lacking, what drug can be administered?

A

Symptomatic hyperprolactinemia - treat with D-agonists to inhibit PRL secretion

40
Q

DOC for central DI

A

desmopressin preferred, but vasopressin can also be used.

Endocrine Two (16 decks)

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