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Endo Repro Exam II > Receptors, Signaling, Hypothalamic, and Pituitary Hormones > Flashcards

Receptors, Signaling, Hypothalamic, and Pituitary Hormones Flashcards

1
Q

Pharmacologic name for growth hormone

A

Somatotropin

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2
Q

Pharmacologic name for insulin growth factor-1 agonist

A

Mecasermin

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3
Q

Pharmacologic somatostatin analogs

A

Octreotide

Lanreotide

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4
Q

Pharmacologic GH antagonist

A

Pegvisomat

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5
Q

Pharmacologic FSH and analogs

A

Follitropin alpha and beta

Urofollitropin

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6
Q

Pharmacologic LH analog

A

Lutropin alpha

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7
Q

Pharmacologic hCG analog

A

Choriogonadotropin alpha

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8
Q

Pharmacologic GnRH analogs

A 
Leuprolide
Gonadorelin
Goserelin
Buserelin
Histrelin
Nafarelin
Triptorelin
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9
Q

Pharmacologic GnRH antagonists

A

Ganirelix, cetrorelix

Degarelix, abarelix

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10
Q

Oral dopamine receptor agonist used predominantly in the therapy of Parkinson disease, but which has other activities including inhibition of prolactin and growth hormone release which has led to its use in acromegaly, infertility, and galactorrhea

A

Bromocriptine

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11
Q

Ergot medication used to tx high levels of prolactin hormone, works by blocking its release from the pituitary gland

A

Cabergoline

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12
Q

Pharmacologic vasopressin receptor agonists

A

Vasopressin

Desmopressin

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13
Q

Vasopressin receptor antagonists

A

Conivaptan

Tolvaptan

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14
Q

What type of receptor, effectors, and signaling pathways are utilized by insulin?

A

Receptor tyrosine kinase

Effectors: tyrosine kinases, IRS-1 to IRS-4

Signaling pathways: MAP kinases, PI 3-kinase, RSK

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15
Q

What type of receptor, effectors, and signaling pathways are utilized by GH and PRL?

A

Cytokine receptor-linked kinase

Effectors: JAK, tyrosine kinases

Signaling pathways: STAT, MAP kinase, PI 3-kinase, IRS-1, IRS-2

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16
Q

What type of receptor, effectors, and signaling pathways are utilized by TGF-beta?

A

Serine kinase

Effectors: serine kinase

Signaling pathways: Smads

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17
Q

What type of receptor, effectors, and signaling pathways are utilized by the following:

Beta-adrenergic
LH, FSH, TSH
Glucagon
PTH, PTHrP
ACTH
GHRH, CRH
A

GPCRs!

Effectors: Ga(s)&raquo_space;»»> Ca2+ channels

Signaling pathways: stimulation of cAMP&raquo_space;»»> Calmodulin, Ca2+ dependent kinases

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18
Q

What type of receptor, effectors, and signaling pathways are utilized by the following:

Alpha-adrenergic
Somatostatin

A

GPCR

Effectors: Ga(i)

Signaling pathways: inhibition of cAMP production, activation of K+, Ca2+ channels

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19
Q

What type of receptor, effectors, and signaling pathways are utilized by the following:

TRH, GnRH

A

GPCRs

Effectors: Ga(q), Ga(11)

Signaling pathways: phospholipase C, DAG, IP3, protein kinase C, voltage-gated Ca++ channels

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20
Q

The ______________ receptor superfamily is a large and heterogenous group of membrane receptors that respond mainly to protein mediators (e.g., insulin, GH, PRL, TGF-beta) and effects are at the level of gene transcription

A

Kinase-linked

[this superfamily of receptors plays a major role in controlling cell division, growth, differentiation, inflammation, tissue repair, apoptosis, and immune responses]

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21
Q

Main types of kinase-linked receptors in endocrine signaling

A

Receptor tyrosine kinases (RTKs)
Serine/threonine kinase receptors
Cytokine receptors

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22
Q

What kind of kinase-linked receptor lacks intrinsic enzyme activity bu, when activated, associate with and activate cytosolic kinases?

A

Cytokine receptors

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23
Q

Kinase signaling cascade mechanism

A

Often, ligand binding to kinase-linked receptors leads to receptor dimerization (interaction between 2 separate receptors)

The close association of the 2 intracellular kinase domains allows autophosphorylation of intracellular tyrosine residues to occur, which serve as high-affinity binding sites for intracellular proteins that form the next step in the signal transduction cascade

The end result is to activate or inhibit (via phosphorylation) a variety of transcription factors that induce or suppress the expression of specific genes

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24
Q

G-proteins consist of 3 subunits: alpha, beta, and gamma. The alpha-subunit binds to _____ nucleotides, activates effector proteins when bound to GTP, and has enzymatic activity (catalyzes the conversion of GTP to GDP resulting in alpha subunit activation)

The beta and gamma subunits form a _____ and remain together as a complex that confers both membrane localization of the G-protein and directs signaling such as activation of ion channels and binding sites for G-protein receptor kinases

A

Guanine

Dimer

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25
Q

_______ = enzyme responsible for cAMP production

______ = enzyme responsible for IP3 and DAG formation

Ion channels (particularly calcium and potassium) and the __________ system (controls activity of many signaling pathways influencing cell growth and proliferation, smooth muscle contraction, etc.)

A

Adenylyl cyclase

Phospholipase C

Rho A/Rho kinase

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26
Q

3 main domains that make up the primary structure of most nuclear receptors

A

Activation function 1 (AF1)

DNA-binding domain (DBD) — highly conserved and functions to recognize and bind specific sequences of DNA (called hormone response elements) upstream of target gene; also plays a role in receptor dimerization

Ligand-binding domain (LBD) — C-terminal LBD selectively binds to agonists or antagonists and confers ligand-dependent activation. Upon ligand binding, LBD undergoes conformation change allowing recruitment of coactivators or corepressors that either activate or repress gene transcription, respectively

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27
Q

2 main classes of nuclear receptors

A

Classic steroid nuclear receptor (GR, MR, ER, PR, AR)

The remaining nuclear receptors include those that bind retinoids, thyroid hormone, vitamin D, xenobiotics, androstane, lipids, and fatty acids

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28
Q

_______ and hormones in the _____ family can stimulate prolactin release

A

TRH; glucagon

[hormonees in glucagon family include secretin, glucagon, VIP, GIP]

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29
Q

What is SRIF?

A

Somatotropin release-inhibiting factor (somatostatin) — hypothalamic hormone that has inhibitory effect on GH release from anterior pituitary

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30
Q

Somatotropin is the recombinant human form of GH (rhGH) used clinically and is identical to the predominant native form of human GH. It is mainly metabolized by the ______ and has an endogenous half life of 20-25 mins, but active blood levels of rhGH persist for 36 hrs. It is a P450 _______

A

Liver; inducer

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31
Q

GH receptors dimerize after binding to GH and activate the ______ signaling pathway (2 molecules are required for activation). Growth promoting effects are mediated through an increase in _____ production

A

JAK/STAT; IGF-1

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32
Q

Effects of GH on musculoskeletal system and carbohydrate metabolism

A

Stimulates longitudinal bone growth until epiphyses close; has anabolic effects in muscle and catabolic effects in lipid cells

Effects on carb metabolism are mixed. GH and IGF-1 have opposite effects on insulin sensitivity — GH reduces insulin sensitivity (mild hyperinsulinemia), IGF-1 acts through IGF-1 and insulin receptors to lower serum glucose and reduce insulin

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33
Q

Clinical uses for GH

A

GH-deficiency in children: therapy with rhGH allows them to reach normal height (can also be used in kids with short stature d/t Prader-Willi, Turner, Noonan, and idiopathic short stature)

GH-deficiency in adults: therapy with rhGH reverses symptoms such as obesity, reduced muscle mass, asthenia, and reduced CO

Wasting in pts with AIDS

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

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34
Q

GH toxicities in kids vs. adults

A

Tx is well tolerated in kids; rare AEs include intracranial HTN (manifested by vision changes, HA, nausea, or vomiting), scoliosis, otitis media in pts with Turner syndrome, hypothyroidism, pancreatitis, gynecomastia

Adults have more adverse effects than children, including peripheral edema, myalgias, arthralgias, carpal tunnel syndrome

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35
Q

Contraindication to GH use

A

Known malignancy

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36
Q

GH exercises its growth effects by stimulating IGF-1 synthesis in the liver and by inducing chondrocyte differentation/replication and local production of IGF-1. What medication is used the rare instances where there is GH insensitivity caused by GH receptor defects of GH-inhibiting antibodies?

A

Injectable recombinant human (rh)IGF-1 (mecasermin)

[used in long-term tx of growth failure and short stature in children with severe primary IGF-1 deficiency, for instance d/t growth hormone deficiency or Laron syndrome (growth hormone insensitivity)]

37
Q

Most common adverse effect of mecasermine

A

Hypoglycemia (eating 20 minutes before helps prevent)

38
Q

Somatostatin inhibits release of GH, glucagon, insulin, and gastrin, and can be used to treat anterior pituitary adenomas that secrete GH. Why does exogenous somatostatin have limited therapeutic value?

A

Short duration of action (half-life of 1-3 mins) and effects on multiple secretory systems

[however, longer-acting analogs have been developed! — octreotide and lanreotide]

39
Q

Most widely used SST analog that is 45x more potent than SST in inhibiting GH release, 2x as potent in reducing insulin secretion, also inhibits GHRH and thyrotropin

A

Octreotide (subcutaneous administration, half life 80 mins) — reduces sxs associated with hormone-secreting tumors: acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, nesidioblastosis, diabetic diarrhea, hypokalemia, achlorhydria (WDHA) syndrome

40
Q

Lanreotide is approved for the tx of _____ and has effects comparable to octreotide.

A

Acromegaly

41
Q

AEs of SST analogs

A

GI — diarrhea, nausea, abdominal pain; Gallbladder sludge and gallstones can develop d/t decreased gallbladder contraction and bile secretion

Cardiac — sinus bradycardia, conduction disturbances

Vitamin B12 deficiency

42
Q

Polyethylene glycol derivative of mutant GH that binds GH receptor and allows receptor to dimerize, but does not activate JAKSTAT signaling cascade or stimulate IGF-1 secretion; used to tx acromegaly

A

Pegvisomant

43
Q

Urofollitropin (uFSH) is purified human FSH extracted from urine of postmenopausal women (no LH activity)

Follitropin alpha and beta are recombinant forms of FSH (rFSH) with amino acid sequences identical to that of human FSH. rFSH preparations have a shorter half life but stimulate estrogen secretion equal to or greater than uFSH (they are more expensive though)

What are the clinical uses of these compounds?

A

Ovulation induction in pts who previously received pituitary suppression (uFSH)

Ovulation induction in pts in whom the cause of infertility is functional and not caused by primary ovarian failure (rFSH alpha and beta)

Spermatogenesis induction (rFSH alpha)

Development of multiple follicles with assisted reproductive technologies

44
Q

Lutropin alpha is the recombinant form of human LH and is only used in combination with ________ for stimulation of follicular development in infertile women with profound LH deficiency

A

Follitropin alpha

45
Q

hCG may be extracted and purified from the urine of pregnant females. Choriogonadotropin alpha (rhCG) is a recombinant form of hCG. What is the clinical use of hCG and rhCG?

A

hCG: Used to induce ovulation and pregnancy in anovulatory, infertile females; tx of hypogonadotropic hypogonadism, spermatogenesis induction with follitropin alpha

rhCG: induces ovulation in infertile females who have been pretreated with FSH; induces ovulation and pregnancy in infertile females when the cause of infertility is functional

46
Q

AEs of tx with hCG or rhCG

A

Uncomplicated ovarian enlargement (usually resolves spontaneously)

Ovarian hyperstimulation syndrome — characterized by ovarian enlargement, ascites, hydrothorax, hypovolemia, sometimes resulting in shock

Risk for multiple pregnancy is 15-20% in ART pts; multiple pregnancies increases risk for gestational diabetes, preeclampsia, and preterm labor

47
Q

Pulsatile vs. continuous administration of GnRH analogs (like leuprolide)

A

Pulsatile IV administration every 1-4 hrs induces FSH and LH secretion

Continuous administration induces biphasic response: During the first 7-10 days, an agonist effect results in increased concentrations of gonadal hormones. After that, the continued presence of GnRH results in an inhibitory action that manifests as a drop in the concentration of gonadotropins and gonadal steroids

48
Q

T/F: GnRH analogs are more commonly used for suppression of gonadotropin release

A

True (although they can occasionally be used for stimulation of gonadotropin production)

49
Q

Clinical situations where stimulation of gonadotropin production by GnRH analogs is useful

A

Infertility (male or female)

Diagnosis of LH responsiveness

50
Q

Clinical situations where suppression of gonadotropin production by GnRH analogs is useful

A

Controlled ovarian hyperstimulation (e.g., to prevent premature ovulation by endogenous LH in IVF pts)

Endometriosis

Uterine leiomyomata (uterine fibroids)

Prostate cancer

Central precocious puberty

51
Q

AEs associated with GnRH analog tx

A

Continuous tx of women with GnRH analog causes typical sx of menopause including hot flashes, sweats, and headaches. In men, continuous administration causes hot flashes, sweats, edema, gynecomastia, decreased libido, decreased hematocrit, reduced bone density.

Additional AEs include depression, diminished libido, generalized pain, vaginal dryness, breast atrophy, and decreased bone density and osteoporosis with long term use

52
Q

Contraindications to GnRH analogs in women

A

Pregnancy and breastfeeding

53
Q

T/F: GnRH agonists have been shown to more completely suppress gonadotropin production compared to GnRH antagonists

A

False, GnRH antagonists more completely suppress

54
Q

Clinical uses for GnRH antagonists Ganirelix and Cetrorelix

A

Controlled ovarian hyperstimulation procedures

[AEs of GnRH receptor antagonists are similar to GnRH agonists]

55
Q

Clinical uses for GnRH antagonists Abarelix and Degarelix

A

Used to tx advanced prostate cancer — reduces concentrations of gonadotropins and androgens significantly more rapidly than GnRH agonists and avoids the testosterone surge

[AEs of GnRH receptor antagonists are similar to GnRH agonists]

56
Q

Bromocriptine and cabergoline are dopamine D2 receptor agonists. Which one has longer half life?

A

Cabergoline (65 hrs vs. 15 hrs)

57
Q

Clinical uses for cabergoline or bromocriptine

A

Standard tx for hyperprolactinemia

Shrink pituitary PRL-secreting tumors, lower circulating PRL levels, and restore ovulation in 70% of women with microadenomas and 30% of women with macroadenomas

Used alone or in combo with pituitary surgery, radiation therapy, or ocreotide administration to tx acromegaly

58
Q

AEs of dopamine agonists

A

Nausea, HA, lightheadedness, orthostatic hypotension, fatigue

Psychiatric manifestations occur occasionally

Pulmonary infiltrates with chronic high-dose therapy

59
Q

Contraindications to dopamine agonist therapy

A

Patients with microadenomas who are pregnant discontinue therapy because microadenoma growth during pregnancy is rare [pts with MACROadenomas who are pregnant will continue therapy]

Not recommended to suppress postpartum lactation d/t increased incidence of stroke or coronary thrombosis

60
Q

Clinical use of oxytocin

A

Administered IV for initiation and augmentation of labor, and IM for control of postpartum bleeding

61
Q

______ is a long-acting synthetic analog of vasopressin with minimal V1 receptor activity and an antidiuretic-to-pressor ratio 3000x that of vasopressin; also has longer half life

A

Desmopressin

62
Q

MOA of desmopressin and vasopressin

A

Activates GPCR V1 receptors (found in vascular smooth muscle cells and mediate vasoconstriction) and V2 receptors (found in renal tubule cells and reduce diuresis through increased water permeability and water resorption in the collecting tubules

Extrarenal V2-like receptors regulate the release of coagulation factor VIII and von willebrand factor (receptor activation leads to release)

63
Q

Desmopressin may be used for tx of coagulopathy in ____ and ____

A

Hemophilia A; von willebrand disease

64
Q

AEs of desmopressin and vasopressin

A

HA, nausea, abdominal cramps, agitation, and allergic reactions occur rarely

Overdose —> hyponatremia, seizures

Vasopressin should be used with caution in pts with CAD d/t vasoconstriction

65
Q

MOA of conivaptan and tolvaptan

A

Antagonists of vasopressin receptors [aka “aquaretics” bc they increase renal free water excretion with little or no change in electrolyte excretion]

Tolvaptan is selective for V2 receptors

Conivaptan is nonselective and blocks V1 and V2

66
Q

In short-term clinical trials in pts with CHF and reduced ejection fraction, _____ decreased body weight and improved dyspnea with no effect on all-cause mortality, CV death, or hospitalization for heart failure

In CHF pts, ______ increases renal free water excretion without a change in systemic vascular resistance

A

Tolvaptan

Conivaptan

67
Q

Conivaptan and tolvaptan are metabolized by ____

A

CYP3A4

68
Q

A 38 y/o female presents to the reproductive endocrinologist for ovarian hyperstimulation. She is administered follitropin alpha, a FSH analog. Activation of which of the following signaling pathways most likely mediates the therapeutic efficacy of this drug?

a. cAMP synthesis
b. IP3 production
c. cGMP synthesis
d. tyrosine residue phosphorylation
e. gene transcription

A

a. cAMP synthesis

69
Q

An 8 y/o healthy female is referred to a pediatric endocrinologist for short stature. Physical examination and karyotype analysis lead to the diagnosis of Turner syndrome. Which of the following agents would be most appropriate?

a. somatotropin
b. somatostatin
c. testerone
d. octreotide
e. cabergoline

A

a. somatotropin

70
Q

An 8 y/o healthy female is referred to a pediatric endocrinologist for short stature. Physical examination and karyotype analysis lead to the diagnosis of Turner syndrome. She is prescribed appropriate therapy. Activation of which of the following signaling pathways most likely mediates the therapeutic efficacy of this drug?

a. cAMP synthesis
b. IP3 production
c. cGMP synthesis
d. tyrosine residue phosphorylation
e. gene transcription

A

d. tyrosine residue phosphorylation

71
Q

A 41 y/o male presents to the hospital for irradiation of the hypophysis due to a parasellar tumor. After treatment, therapy with somatropin is started. Which of the following adverse effects is most likely?

a. arthralgias
b. hypoglycemia
c. weight loss
d. osteoporosis
e. dehydration

A

a. arthralgias

72
Q

A 37 y/o female recently diagnosed with pituitary adenoma undergoes ablative radiation therapy, but the treatment fails to control the patient’s symptoms. Lab tests still show a high level of insulin-like growth factor 1 (IGF-1). Octreotide is prescribed. Which of the following actions most likely mediates the therapeutic effects of the drug in this patient’s disorder?

a. stimulation of GH metabolism
b. inhibition of GH release
c. inhibition of insulin release
d. blockade of GH receptors
e. blockade of TSH receptors

A

b. inhibition of GH release (somatostatin analog)

73
Q

A 56 y/o male recently diagnosed with carcinoid tumor of the lung started treatment that includes octreotide. He is most likely at increased risk of which of the following adverse effects?

a. drowsiness
b. gallstones
c. hypoglycemia
d. heat intolerance
e. flushing

A

b. gallstones

74
Q

A 36 y/o male presents with elevated serum levels of IGF-1. A thorough workup results in a diagnosis of acromegaly and he undergoes radiation therapy. Since then, he has been taking octreotide. Addition of which drug would be most appropriate to combine with his current medication?

a. desmopressin
b. leuprolide
c. mecasermin
d. methimazole
e. pegvisomant

A

e. pegvisomant

75
Q

An 8 y/o male is referred to a pediatric endocrinologist because of growth retardation. Lab tests show increased serum growth hormone levels but very low serum levels of insulin-like growth factor 1 (IGF-1). He is diagnosed with Laron dwarfism. Which of the following drugs would be most appropriate?

a. somatotropin
b. octreotide
c. mecasermin
d. oxandrolone
e. cabergoline

A

c. mecasermin

76
Q

A 36 y/o female presents with a 2 month history of amenorrhea and a white discharge from her breasts for the past month. Imaging shows a pituitary adenoma. A drug with which of the following mechanisms would be most appropriate?

a. stimulation of dopamine synthesis
b. stimulation of GH metabolism
c. blockade of GH receptors
d. blockade of D2 receptors
e. activation of D2 receptors

A

e. activation of D2 receptors

77
Q

We prescribe bromocriptine for a woman with primary amenorrhea. Normal menstruation returns about a month after starting therapy. Which of the following statements best describes the mechanisms by which bromocriptine caused its desired effects?

a. blocked estrogen receptors, enhanced gonadotropin release
b. increased FSH synthesis
c. inhibited PRL release
d. stimulated ovarian estrogen and progestin synthesis
e. stimulated GnRH release

A

c. inhibited PRL release

78
Q

A 55 y/o female is admitted to the emergency department in septic shock. Despite fluid therapy and norepinephrine, she remains hypotensive (80/50 mmHg) and tachycardic (120 bpm). An additional drug is given via IV infusion and her blood pressure increases to 106/75 mmHg. Her pulse is 88 bpm. Which of the following was most likely given to the patient?

a. epinephrine
b. desmopressin
c. phenylephrine
d. dobutamine
e. vasopressin

A

e. vasopressin

79
Q

A young couple (25-year-old male, 23-year-old female) wants to start a family. They have not conceived after 1 yr of unprotected intercourse. Infertility evaluation revealed no abnormalities in the female partner and low sperm count in the male. Which of the following is a drug that is purified from the urine of postmenopausal women and is used to promote spermatogenesis in infertile men?

A. Desmopressin 
B. Gonadorelin 
C. Goserelin
D. Somatropin
E. Urofollitropin
A

E. Urofollitropin

Spermatogenesis in males requires action of FSH and LH. Urofollitropin, which is purified from urine of postmenopausal women, is used clinically to provide FSH activity

80
Q

A 29-year-old woman in her 41st wk of gestation had been in labor for 12 h. Although her uterine contractions had been strong and regular initially, they had diminished in force during the past hour. Which of the following agents would be used to facilitate this woman’s labor and delivery?

A. Dopamine 
B. Leuprolide 
C. Oxytocin
D. Prolactin
E. Vasopressin
A

C. Oxytocin

Oxytocin is an effective stimulant of uterine contraction that is routinely used to augment labor.

81
Q

A 3-year-old boy with failure to thrive and metabolic disturbances was found to have an inactivating mutation in the gene that encodes the growth hormone receptor. Which of the following drugs is most likely to improve his metabolic function and promote his growth?

A. Atosiban
B. Bromocriptine 
C. Mecasermin 
D. Octreotide
E. Somatropin
A

C. Mecasermin

This child’s condition is d/t the inability of GH to stimulate the production of insulin-like growth factors, the ultimate mediators of GH effects. Mecasermin, a combination of recombinant IGF-1 and the binding protein that protects IGF-1 from immediate destruction, will help correct the IGF deficiency. Because of the inactive GH receptors, somatotropin will not be effective

82
Q

An important difference between leuprolide and ganirelix is that ganirelix

A. Can be administered as an oral formulation
B. Can be used alone to restore fertility to hypogonadal men and women
C. Immediately reduces gonadotropin secretion
D. Initially stimulates pituitary production of LH and FSH
E. Must be administered in a pulsatile fashion

A

C. Immediately reduces gonadotropin secretion

Leuprolide is an agonist of GnRH receptors, whereas ganirelix is an antagonist. Although both drugs can be used to inhibit gonadotropin release, ganirelix does so immediately, whereas leuprolide does so only after about 1 wk of sustained activity

83
Q

A 27-year-old woman with amenorrhea, infertility, and galactorrhea was treated with a drug that successfully restored ovulation and menstruation. Before being given the drug, the woman was carefully questioned about previous mental health problems, which she did not have. She was advised to take the drug orally. Which of the following is most likely to be the drug that was used to treat this patient?

A. Bromocriptine
B. Desmopressin
C. Human gonadotropin hormone 
D. Leuprolide
E. Octreotide
A

A. Bromocriptine

??

84
Q

A 3-year-old girl was referred to the genetic counselor by her pediatrician. She presents with short stature (height is 85 cm, –3 standard deviations) and appears to have loose skin on her neck. Cytogenetic testing reveals an XO karyotype. Which of the following drugs will allow her to achieve a higher adult height?

A. Adrenocorticotropin (ACTH)
B. Corticotropin-releasing hormone (CRH)
C. Growth hormone-releasing hormone (GHRH) 
D. Gonadotropin-releasing hormone (GnRH)
E. Somatropin
A

E. Somatotropin

ACTH is used diagnostically in suspected adrenal insufficiency. CRH is used to distinguish Cushing’s syndrome from ectopic ACTH secretion. GHRH is rarely used as treatment. Its main use is as a diagnostic tool. GnRH can be used to treat infertility. Somatotropin, recombinant human GH, promotes growth in children with Turner’s syndrome (an XO genotype) or chronic renal failure. It also helps with AIDS-associated wasting syndrome

85
Q

A 3-year-old girl presented with hirsutism, breast enlargement, and a height and bone age that was consistent with an age of 9. Diagnostic testing revealed precocious puberty. Which of the following is the most appropriate drug for treatment of this patient’s precocious puberty?

A. Atosiban
B. Follitropin
C. Leuprolide 
D. Octreotide 
E. Pegvisomant
A

C. Leuprolide

In precocious puberty, the hypothalamic-pituitary-gonadal axis becomes prematurely active for reasons that are not understood. Tx involves suppressing gonadotropin secretion with continuous administration of a long-acting GnRH agonist such as leuprolide

86
Q

A 47-year-old man exhibited signs and symptoms of acromegaly. Radiologic studies indicated the presence of a large pituitary tumor. Surgical treatment of the tumor was only partially effective in controlling his disease. At this point, which of the following drugs is most likely to be used as pharmacologic therapy?

A. Cosyntropin 
B. Desmopressin
C. Leuprolide
D. Octreotide
E. Somatropin
A

D. Octreotide

Octreotide is a somatostatin analog that has some efficacy in reducing the excess GH production that causes acromegaly

87
Q

A 37-year-old woman with infertility due to obstructed fallopian tubes was undergoing ovulation induction in preparation for in vitro fertilization. After 10 d of treatment with leuprolide, the next step in the procedure is most likely to involve 10–14 d of treatment with which of the following?

A. Bromocriptine 
B. Follitropin
C. Gonadorelin 
D. hCG
E. Pergolide
A

B. Follitropin

Once the pts endogenous gonadotropin production ha sbeen inhibited through continuous administration of the GnRH agonist leuprolide, the next step in ovulation induction is the administration of a drug with FSH activity to stimulate follicle maturation. Follitropin is recombinant FSH. The only other drug listed that is used in ovulation induction is hCG, but this is an LH analog

88
Q

A 7-year-old boy underwent successful chemotherapy and cranial radiation for treatment of acute lymphocytic leukemia. One month after the completion of therapy, the patient presented with excessive thirst and urination plus hypernatremia. Laboratory testing revealed pituitary diabetes insipidus. To correct these problems, this patient is likely to be treated with which of the following?

A. Corticotropin 
B. Desmopressin 
C. hCG
D. Menotropins 
E. Thyrotropin
A

B. Desmopressin

Pituitary diabetes insipidus results from deficiency in vasopressin. It is treated with desmopressin, a peptide agonist of vasopressin V2 receptors

Endo Repro Exam II (28 decks)

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