Kruse: hypothalamic and pituitary hormones

Question 1

Growth hormone

Answer 1

Somatropin

Question 2

IGF-1 agonist

Answer 2

Mescasermin

Question 3

Somatostatin analogs

Answer 3

• Octreotide

- Lanreotide

Question 4

GH antagonist

Answer 4

Pegvisomant

Question 5

Dopamine agonists

Answer 5

• Bromocriptine

- Cabergoline

Question 6

Vasopressin receptor agonists

Answer 6

• Vasopressin

- Desmopressin

Question 7

Vasopressin receptor antagonist

Answer 7

• Conivaptan

- Tolvaptan

Question 8

Anterior pituitary hormones are negatively regulated by what hypothalamic peptides and catecholamines?

Answer 8

• Somatostatin

- dopamine

Question 9

These are single chain protein hormones that activate kinase linked receptors of the JAK/STAT superfamily

Answer 9

GH and prolactin

Question 10

These are dimeric proteins that activate G protein couples receptors

Answer 10

• TSH
• FSH
• LH

Question 11

This is a single peptide cleaved from a larger precursor contains the peptide B-endorphin that also binds GPCRs

Answer 11

ACTH

Question 12

Growth hormone production is stimulated by GHRH and inhibited by what?

Answer 12

peptide somatostatin (SST)

Question 13

Prolactin is inhibited by dopamine via what receptor?

Answer 13

D2

Question 14

Disruption of the pituitary stalk and the hypothalamohypophysial portal vessels will do what to prolactin?
What happens to rest of the anterior pituitary hormones?

Answer 14

increase

decrease

Question 15

Syndromes where you can use GH

Answer 15

• Prader Willi
• Turner
• Noonan

Question 16

other uses for GH

Answer 16

• Wasting in patients with AIDS

- Patients with short bowel syndrome who are dependent on total parenteral nutrition

Question 17

GH toxicity and contraindication

Answer 17

• Rare in children: intracranial HTN (vision changes, headache, nausea, vomiting), scoliosis, otitis media in patients with Turner syndrome, hypothyroidism, pancreatitis, gynecomastia
• Adults: peripheral edema, myalgias, arthralgias, carpal tunnel syndrome
• Contraindicated in patients with a known malignancy

Question 18

A small number of children with growth failure have severe IGF-1 deficiency that is not responsive to exogenous GH due to what?

Answer 18

mutations in GH receptor and development of neutralizing antibodies to GH

Question 19

What is mecasermin a complex of

Answer 19

rhIGF-1 and rhIGFBP-3 (this is needed to increase half life of rhIGF-1)

Question 20

Mecasermin is administered how

Answer 20

SQ

Question 21

most common adverse effect of Mecasermin

Answer 21

-hypoglycemia: eating 20 minutes before administration prevents this

Question 22

What is the most widely used SST analog

Answer 22

Octreotide

Question 23

Octreotide reduces what symptoms associated with hormone secreting tumors?

Answer 23

• Acromegaly
• Carcinoid syndrome
• Gastrinoma
• Glucagonoma
• Nesidioblastosis
• diabetic diarrhea
• watery diarrhea
• hypokalemia
• achlorhydria (WDHA) syndrome

Question 24

Lanreotide is approved for treatment of what?

Answer 24

acromegaly

Question 25

Adverse effects of SST analogs

Answer 25

- GI - Gallbladder sludge and gallstones - Cardiac effects (sinus bradycardia, conduction disturbances) - vitamin B12 deficiency

Question 26

What is Pegvisomant used to treat

Answer 26

Acromegaly

Question 27

Toxicity and contraindications for Dopamine agonists?

Answer 27

- nausea, headache, light headedness, orthostatic hypotension, fatigue are most common - Psychiatric manifestation - Pulmonary infiltrated may occur with chronic high dose - Patients with MACROadenoma and pregnant . .continue - if MICRO then discontinue - Dopamine agonists are not recommended to suppress postpartum lactation due to increased incidence of stroke or coronary thrombosis

Question 28

Receptors for vasopressin

Answer 28

- V1: vascular smooth muscle cells --> vasoconstriction - V2: renal tubule cells --> reduce diuresis through increased water permeability and water resorption n collecting tubules - Extrarenal V2 . . release of coagulation factor VIII and vWF

Question 29

What is preferred for central diabetes insipidus, Desmopressin or vasopress

Answer 29

Desmopressin . . due to selectivity for V2

Question 30

When is desmopressin used

Answer 30

treatment of coagulopathy in hemophilia A and Von Willebrand disease

Question 31

Toxicity and contraindications for Vasopressin and desmopressin

Answer 31

- headache, nausea, abdominal cramps, agitation, and allergic reactions occur rarely - Overdose: hyponatremia and seizures - Vasopressin should be used with caution in patients with coronary artery disease due to vasoconstriction

Question 32

Which vasopressin Antagonist is selective for V2? | Which binds to both?

Answer 32

- Tolvaptan | - Conivaptan

Question 33

Metabolism of vasopressin antagonists?

Answer 33

CYP3A4