Mod 1 lecture 1: hypothalamic-pituitary-gonadal axis

Question 1

what hormones does the hypothalamus release

Answer 1

GHRH
CRH
TRH
GnRH
(PRH;?TRH)

Question 2

what are inhibiting hormones secreted by hypothalmus

Answer 2

somatostains (GHIH and TSH)
Dopamine (PIH)

Question 3

what does GH stimulate

Answer 3

liver and increases somatomedins

Question 4

what is another name for growth hormone

Answer 4

somatotropin

Question 5

what tissues does GH target

Answer 5

bone, adipose, liver, muscle and growth plates

Question 6

what are the growth hormone release modulators

Answer 6

somatotropin (genotropin, humatrope)
octreotide (sandostatin)
Pegvisomant(somavert)

Question 7

what is somatropin

Answer 7

synthetic somatotropin (human GH)

Question 8

what are the indications for somatropin

Answer 8

GH deficiency
Growth failure (turner syndrome, Noonan syndrome, prader-willi syndrome)
HIV patients with cachexia

Question 9

what are the AE of somatropin

Answer 9

pain at injection side
edema
arthralgia and myalgia
nausea
glucose tolerance: insulin insensitivity

*warning:
do not use in pediatric patients with closed epiphyses
increased ICP

Question 10

What is somatostatin

Answer 10

inhibitory hormone of GH
Hypothalamus:
-acts on anterior pituitary gland
-binds to pituitary GHRH receptors
-suppresses GH and TSH release
GI tract: supresses secretions and motility

Question 11

What is Octreotide

Answer 11

long-acting synthetic somatostatin analog - GH release suppression
DOA: 12hrs to 6 weeks
GH release modulator

Question 12

what are the inidcations of Octreotide

Answer 12

acromegaly
Severe diarrhea caused by carcinoid tumor
bleeding esophageal varices

Question 13

what are the AE of octreotide

Answer 13

CVS: bradycardia and conduction distrubances
GI: diarrhea, abdominal pain, flatulance, nausea and streatorrhea

Question 14

What is Pegvisomant

Answer 14

GH receptor antagonist - modified HGH with receptor blocking-properties

Question 15

what are the indications for Pegviosomant

Answer 15

acromegaly that is refractory to other pharmacological surgical or radiological intervention

Question 16

What are the AE of Pegviosomant

Answer 16

GI: diarrhea and nausea
CNS: pain
Hepatic: abnormal hepatic function tests

Question 17

What is ACTH

Answer 17

corticotropin - naturally occuring hormones

Question 18

What is ACTH

Answer 18

corticotropin - naturally occuring hormones
anteriro pituitary homrone
stimulates steroid biosynthesis

Question 19

what is cortosyn

Answer 19

cosyntropin - sythesized ACTH hormon

Question 20

What is CRH

Answer 20

corticotropin - releasing homrone
hypothalamic hormone
regulates synthesis and release of ACTH

Question 21

What is Cosyntropin

Answer 21

synthtic ACTH
full biological potency
stimulates adrenal cortex to secrete adrenal steroids (cortisol), androgenic substances, and a small amount of aldosterolne

Question 22

what are the indications for Cosyntropin

Answer 22

diagnostic tool for ACTH stimulation test
screening for adrenocorticosteroid deficiency - primary adults insufficiency (hypoadrenaliism - addisons disease)

Question 23

What are the AE of Cosyntropin

Answer 23

excess glucocoriticoid toxicities:
HTN, peripheral edema, hypokalemia, osteoporosis

Question 24

What is GnRH

Answer 24

gonadotropin-releaseing hormone
secreted from the hypothalamus
binds to receptors in anterior pituitary gland
release in gonadotropins (FSH and LH)

Question 25

what is essential for gonadotropin rlease

Answer 25

pulsatile secretion

Question 26

what results in the down regulation of GnRH receptors and suppression of gonadotropin release

Answer 26

continuous secretion

Question 27

what are the indicatiosn for suppression of gonadotropin production

Answer 27

prostate cancer endometriosis and uterine myomas (fibroids) precocious puberty infertility treatment: controlled ovarian stimulation, suppression of LH surge and ovulation suppressing sex hormones in transgender people

Question 28

what are the adverse effects of FSH-LH release modulators in females

Answer 28

generalized menopausal symptoms ovarian cysts

Question 29

what are the AE of FSH-LH release modulators in males

Answer 29

transient increase in testosterone hot flashes, sweats, edema, gynecomastia, decreased libido, decreased HCT, and bone density

Question 30

What is Leuprolide (lupron) used for

Answer 30

used to treat prostate cancer, breast cancer, endometriosis, uterine fibroids and early puberty can delay the onset of puberty in transgender youth prior to initiation of HRT can be used to delay or prevent early ovulation in order to allow for the development of mature eggs for retrieval in IVF cycles

Question 31

What is goserelin (zoladex)

Answer 31

used to suppress production of sex hormones (testosterone and estrogen), particularly in the treatment of breast and prostate cancer

Question 32

what is nafarelin (synarel)

Answer 32

used in the treatment of endometriosis and early puberty

Question 33

what is histrelin (vantas)

Answer 33

used to treat advanced prostate cancer in adults,. will reduce level of testosterone

Question 34

what is Prolactin

Answer 34

hormone secreted from the anterior pituitary stimulates and maintains lactation decreases libido

Question 35

what regulates prolactin

Answer 35

tonic inhibition by dopamine - dopamine antagonists (antipsychoatics) increase prolactin secretion TRH also stimulates the release of prolactin

Question 36

what is Bromocriptine

Answer 36

dopamine receptor agonist that treats hyperprolactinemia, parkinsons disease

Question 37

what is cabergoline

Answer 37

first-line agent in the management of prolactinomas due to its higher affinity for D2 receptor sites, less severe side effect and more convenient dosing schedule than bromocriptine

Question 38

what are the indications for bromocriptine and cabergoline

Answer 38

D2 receptor agonists - suppress prolactin release Lactotroph adenomas (prolactinomas) - hyper prolactemia

Question 39

what are the affects that Bromocriptine has on T2DM

Answer 39

acts on circadian neuronal activities in the hypothalamus to reset an abnormally elevated hypothalatic drive for increase plasma glucose, free fatty acids, and triglycerides in insulin-resistant patients minimally effecting at decreasing A1C (0.5%)

Question 40

what are the AE of bromocriptine and cabergoline

Answer 40

CNS: HA, Dizziness, psychosis GI: nausea

Question 41

what hormones are secreted by posterior pituitary gland

Answer 41

oxytocin vasopressin desmopressin

Question 42

what tissues are targeted by oxytocin

Answer 42

uterus and breast - contraction and milk expression

Question 43

what tissues are targeted by vasopressin (aka ADH)

Answer 43

Nephron (CT and CD) - V2 receptors - water reabsoprtion and hyponatremia vascular smooth muscle - v1 receptors - vasoconstriction

Question 44

what is the use of oxytocin

Answer 44

stimulate uterine contraction labor induction postpartum hemorrhage

Question 45

what are the AE of oxytocin

Answer 45

hypotension and arrhythmias fluid retention (ADH effects) placental abruption or uterine rupture fetal distress and death

Question 46

what is vasopressin

Answer 46

synthetic vasopressin (ADH analog) stimulates arginine vasopressin receptors (AVP) desmopressing has selective V2 activity

Question 47

what are the indications for vasopressin

Answer 47

central diabetes insipidus (absence of ADH) nocturnal enuresis

Question 48

what are the AE of Vasopressin

Answer 48

water intoxication and hyponatremia HA, bronchconstriction and tremor *warning: caution when using vasopressin in patients with CAD, epilepsy and asthma Nasal spray has been linked to increased seizures in children