Endo 2: 13 Gonadotropins And Gnrh

Front 1

27-y-o woman with chief complaint of severe pelvic pain associated with menstruation and mild to moderate pain on non-menstrual days. The occurrence of pain has increased in severity and frequency over the last several months.
Meds – NSAIDS to reduce menstrual pain (ineffective) and low dose OC
Physical normal except for diffuse uterine and adnexal tenderness.
What is this?

Back 1

endometriotic lesions – it is supposed to be in the lining of the uterus but sometimes they can escape and start growing elsewhere causing pain, adhesions, and infertility. This pt is displaying the pain associated with them. Worse on the period.

Front 2

Tx options for endometriotic lesions 5

Back 2

Surgery – conservative vs. definitive
Danazol
NSAIDs
GnRH analogs
Oral Contraceptives

Front 3

pituitary hormones are what kind of stucture? exceptions?

Back 3

Peptides

GH, gonadotropins

Front 4

What is Gonadotropin Releasing Hormone (GnRH)?

Back 4

Peptide synthesized in hypothalamus and transported to the anterior pituitary via portal circulation

Front 5

What is no longer used for the induction of ovulation but may be used diagnostically?

Back 5

Gonadorelin (natural GnRH)

Front 6

What are the long acting analogs of GnRH? 5

Back 6

1. histrelin
2. leuprolide
3. gosrelin
4. triptoreline
5. nafareline

Front 7

What types of drugs are -relins and leuprolide?

Back 7

long acting analogs of GnRH

Front 8

What is the MOA for long acting analogs for the tx of PMS, endometriosis, prostate cancer, and central precocious puberty. Experimental use as male contraceptive?

Back 8

Long lasting drugs produce higher blood levels of GnRH so you get more FSH and LH released until the body senses this and down regulates receptors. Long acting analogs first stimulate but eventually act as antagonists or blockers.

Front 9

Even though they are used as antagonists, analogs initially cause _________ gonadotropin release.

Back 9

increased

Front 10

what hormone will stimulate the endometriotic lesions?

Back 10

estrogen.

Front 11

What are the GnRH antagonists?

Back 11

1. ganirelix - inhibits LH surges
2. cetrorelix
3. abarelix
4. dearelix - prostate cancer

Front 12

What are the GnRH antagonists used for?

Back 12

1. Used to inhibit premature LH surges prior to harvesting eggs for in vitro fertilization
2. a GnRH receptor antagonist used to treat advanced prostate cancer ( may cause life threatening allergy)

Front 13

What are the -relix drugs and what are they used for?

Back 13

- GnRH antagonists
- inhibits premature LH surges b/f harvesting eggs and prostate cancer

Front 14

with prolonged use, what problem do you need to consider with GnRH drugs (-relix and -relins)?

Back 14

can lead to menopause earlier in life

Front 15

What is the chemistry of Luteinizing hormone (LH, interstitial cell stimulating hormone)?

Back 15

glycoprotein hormone with 2 peptide chains

Front 16

What are the Physiological actions of LH: mechanism ? What receptor does it activate?

Back 16

Mechanism – LH receptor stimulation activates Gs

Front 17

LH physiological action on the ovary?

Back 17

Ovary – promotes ovulation and luteinization of ovarian follicles; stimulates synthesis and secretion of estrogen and progesterone from corpus luteum

Front 18

LH physiological action on the testes?

Back 18

Testis – stimulate interstitial (leydig) cells to secrete androgens

Front 19

What can luteinizing hormone tx?

Back 19

- Infertility – menotropins (a mixture of urinary LH and FSH) and chorionic gonadotropin have been used to induce ovulation. Recombinant human LH lutropin alpha (Luveris) is now available.
- May also increase fertility in men

Front 20

What drug tx infertility?

Back 20

luteinizing hormone

Front 21

What drug tx prostate cancer and is used in in vitro fertilization?

Back 21

GnRH antagonists (relix)

Front 22

What drug txs endometriotic lesions?

Back 22

long acting GnRH (leuprolide and -relin)

Front 23

How do you predict the time of ovulation/with what hormone?

Back 23

piss test/ luteinizing hormone

Front 24

What is an adverse effect of the luteinizing hormone? 2

Back 24

1. Multiple pregnancies
2. hyperstimulation of ovary (OHSS) may occur - rupture

Front 25

What drugs can cause multiple preggos and a ruptured ovary?

Back 25

luteinizing hormone

Front 26

What is the follicle stimulating hormone (FSH) chemistry?

Back 26

glycoprotein with 2 peptide chains.

Front 27

What are the follicle stimulating hormone (FSH) agents? 2

Back 27

1. recombinant human FSH, follitropin
2. urinary human FSH, urofollitropin

Front 28

What are recombinant human FSH, follitropin and urinary human FSH, urofollitropin? Uses?

Back 28

- follicle stimulating hormone (FSH) agents
- promotes ovulation
- stimulates testicular growth and maintains seminiferous tubules

Front 29

What receptor does FSH/follitropin/urofollitropin activate?

Back 29

Gs

Front 30

What is the clinical action of FSH/follitropin/urofollitropin?

Back 30

promotes ovulation

Front 31

FSH/follitropin/urofollitropin actions on the ovary?

Back 31

promote follicular development

Front 32

FSH/follitropin/urofollitropin actions on the testes?

Back 32

stimulate testicular growth and maintain seminiferous tubules

Front 33

FSH/follitropin/urofollitropin adverse effects? 2

Back 33

OHSS and multiple pregnancies

Front 34

What is the chemistry of Chorionic gonadotropin (hCG)? made by? agent?

Back 34

glycoprotein with 2 polypeptide chains.
Synthesized by syncytiotrophoblasts of placenta. Recombinant hCG, choriogonadotropin alfa is used clinically.

Front 35

What is choriogonadotropin alfa ? physio action?

Back 35

- Recombinant hCG

- stimulate and sustain function of corpus luteum

Front 36

What are the clinical applications of choriogonadotropin alfa/ Chorionic gonadotropin (HCG)? 2

Back 36

1. induction of ovulation
2. promote descent of testes in cryptorchism

Front 37

how does hCG help Manny be Manny?

Back 37

hCG used to re-start testosterone synthesis after using anabolic steroids...tisk tisk.

Front 38

What does LH do in males?

Back 38

hits Leydig cells to secrete androgens (testosterone)

Front 39

What is lutropin?

Back 39

LH

Front 40

What is Follitropin?

Back 40

FSH

Front 41

adverse effects of follitropin?

Back 41

OHS, multiple pregnancies

OHS=Hyperstimulation of ovary (can cause ascites, pleural effusion, shock)

Front 42

hCG acts just like what?

Back 42

LH

Front 43

actions of choriogonadotropin

Back 43

this is hCG

stimulate and sustain function of corpus luteum (progesterone maintenance)

Front 44

Leuprolide is what kind of drug?

Back 44

GnRH

Front 45

how does leuprolide affect LH/FSH levels

Back 45

GnRH is normally pulsatory

this drug is long acting and NOT pulsatory (so initially you have an increase release of LH/FSH)

after a few days the receptors downregulate and you end up seeing DECREASED release of LH/FSH