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50 Cards in this Set

  • Front
  • Back
GHRH, relased from the hypothalamus, stimulates the secretion of ______ from the pituitary
Growth Hormone
What directly inhibits the release of growth hormone?
Somatostatin
A deficiency in which hormone(s) can cause short stature?
(select all that apply)

A. Dopamine
B. Growth hormone
C. Prolactin
D. TSH
E. Cortisol
F. Thyroid hormone
G. Somatostatin
H. IGF-1
I. GHRH
B. Growth hormone
D. TSH
F. Thyroid hormone
H. IGF-1
I. GHRH
The major regulator of prolactin is _______ which is released from the ________ .
Dopamine

hypothalamus
MOA: Dopamine inhibiting prolactin
Dopamine (aka prolactin-inhibiting
hormone) from the hypothalamus binds to D2 receptors on lactotroph cells of the anterior pituitary
Differentiate between primary, secondary and tertiary growth hormone deficiency.
Defective hypothalamic release of GHRH
(tertiary disease)

Pituitary insufficiency of GH (secondary disease)

Failure of IGF-1 secretion in response to GH
(primary disease)
List the forms of growth hormone available for clinical use
Somatropin

Somatrem
What are Somatropin and Somatrem?
Forms of recombinant GH
Why do we use Somatropin and Somatrem in pediatric patients?
It is best used BEFORE epiphyseal plates have closed
Clinical Use:

- Growth hormone deficiency in children
Congenital or acquired form

- Other conditions associated with short stature despite adequate GH production
Turner’s syndrome
End stage renal disease in children

-Idiopathic, non-GH-deficient short stature

- Anti-aging supplements

- Athletes for a purported increase in muscle mass and athletic performance. Banned by the Olympic Committee.

- AIDS-associated wasting

- Malabsorption associated with **short bowel syndrome**
Somatropin

Somatrem

(recombinant GH)
How can end stage renal disease
cause short stature?
Decreased filtration of some IGF binding proteins

Binds more IGF-1 in the serum
(hence inactive)

Less effect on bone growth
How do Somatropin and Somatrem treat Malabsorption associated with short bowl syndrome?
GH stimulates growth and adaptaion of GI epithelial cells
What amino acid releases GH?
argenine
One of your pediatric patients is very short in stature so you decide to give a drug that will help stimulate growth. The patient has has success for months but now is seeing you with a displacement of the portion of the proximal femur distal to the growth plate.

Whats the drug? What happened?
Somatropin and Somatrem

**Slipped Capital Femoral Epiphysis**
(SCFE)

- Growth hormone can cause rapid bone growth and expansion of the zone of hypertrophy in the growth plate

- Epiphyseal growth plate is unusually widened and weakened

- Growth plate is less able to handle shearing forces
Side effects of rapid growth in children?
- Scoliosis

- Slipped capital femoral epiphysis (SCFE)
What type of endocrine disorders
might occur with GH therapy?
**Hypothyroidism**
( pos. feedback: GH stimulates somatostatin → inhibits TSH)

**Insulin Resistance**
GH Common Adverse Effects in Adults?
Peripheral edema

Carpal tunnel syndrome

Myalgias and arthralgias
A 5-year-old girl is evaluated and determined to have short stature. A GH stimulation test revealed a normal basal level of GH, and an elevation in serum GH levels post-stimulation, but IGF-1 levels were very low in both cases.

What is the most likely cause?
There is problem with the GH receptor!

(IGF-1 levels are low and are stimulated by GH binding to its receptor!!)
Mecasermin is a complex of _____ and _________
Complex of:

Recombinant human insulin-like growth factor-1 (rhIGF-1)

Recombinant human insulin-like growth factor binding protein-3 (rhIGFBP-3)
Clinical Use:

** Severe primary IGF-1 deficiency **
(typically a mutation on GH receptor)
Mecasermin
Adverse Effect:

**Hypoglycemia**

- Eat 20 min before or after taking the drug –to avoid hypoglycemia
mecasermin

(Acts like insulin!!!!)
A 36-year-old male presented with a 12-month history of arthralgia, hyperhidrosis, headaches, and sleep apnea. He states his shoe size has increased and that he ran into an old college friend who commented that his jaw has gotten larger. Magnetic resonance imaging (MRI) showed an enlarged pituitary fossa harboring a soft tissue mass extending into the suprasellar cistern. What would you expect to see on his labs?
↑ IGF-1 from pituitary adenoma!!
How can you stop the effects of excess growth hormone from a pituitary adenoma?
Surgery/Radiation

Block GH receptor

Use Somatostatin to block GH release
What inhibits the release of GH from the pituitary?
(select all that apply)

A. Arginine
B. GH
C. CRH
D. IGF-1
E. GHRH
F. Insulin-induced
hypoglycemia
G. Somatostatin
H. Ghrelin
GH (feedback)

IGF-1 (feedback)

Somatostatin
Feedback Loop
Name the drug class:

Octreotide
Lanreotide
Pegvisomant
Bromocriptine
Cabergoline
GH Antagonists
Which 2 growth hormone antagonists are somatostatin analogs?
Octreotide

Lanreotide
Which Somatostatin analog (GH antagonsit) has the longest half life and has a greater:
-inhibition of GH
-inhibition of glucagon, insulin and gastrin release

Than somatostatin in the body?
Octreotide
MOA: Octreotide and Lanreotide in ancromegaly and gigantisim
Activates Somatostatin receptor

↓ Growth Hormone

↓ IGF-1
MOA: Octreotide and Lanreotide in Carcinoid syndrome Diarrhea from
pancreatic VIPoma
Activates Somatostatin receptor of tumor

↓ Released Hormones

↓ Diarrhea, flushing, etc...
Clinical Use:

Acromegaly (adults) or gigantism (children)

Carcinoid syndrome

Diarrhea from pancreatic VIPoma
Octreotide

Lanreotide

(GH antagonists)
Adverse Effects:

Inhibit gallbladder
contraction, Decrease bile
secretion

"Biliary Sludge" and Gallstones
Octreotide

Lanreotide
Adverse Effects:

Inhibit secretion of insulin and glucagon

Hypoglycemia, Hyperglycemia
Octreotide

Lanreotide
Adverse Effects:

Inhibit secretion of thyrotropin

Hypothyroidsm
Octreotide

Lanreotide
Adverse Effects:

Alter absorption of GI dietary fats

Steatorrhea
Octreotide

Lanreotide
What type of drug is Pegvisomant?
GH receptor antagonist
How does Pegvisomant prevent acromegaly caused by pituitary adenoma (↑GH)?
Blocks GH receptors on liver and other tissues

↓IGF-1

↓GROWTH
Excessive amounts of ____ lead to acromegaly in adults
IGF-1

(released by excessive GH)
This drug normalizes serum IGF-1
concentrations in persons with
acromegaly.
Pegvisomant
Name the dopamine agonists (2)
Bromocriptine

Cabergoline
Name the drug class:

Bromocriptine

Cabergoline
Dopamine Agonists (D2)
A 32-year-old female presents to her gynecologist because
she has had no menses for the past 8 months. She reports
a negative pregnancy test at home. She also has frequent
headaches, a change in vision, and a milky discharge from the breast. She has no medical problems and is not taking any medications. Magnetic resonance imaging (MRI) reveals a mass, 3 mm in diameter, in the anterior lobe of the pituitary. What does she most likely have?
Hyperprolactinemia
Why does a prolactinoma cause
amenorrhea (women), infertility, loss of libido, and galactorrhea (men and women)?
HIGH levels of prolactin inibit GnRH release!
Prolactin is released from _____
pituitary gland
If you had a pituitary adenoma that is secreting too much prolactin, how can you treat it pharmacologically?
Use a D2 AGONIST

Dopamine inhibits prolactin release!
Which of the dopamine agonist has the longest half-life with the fewest side effects?
Cabergoline
What would cabergoline do for a
pre-menopausal female with a
prolactinoma?
↓ prolactin

shrink tumor

restore ovulation
A frequent side effect of dopamine is Postural Hypotension. Please explain
At low doses, dopamine causes VASODILATION
A less frequent side effect of dopamine is digital vasospasm. Please explain.
Dopamine activates α-1 receptors causing vasocontriction!!
How could a prolactinoma cause vision loss? What drug would you use to treat?
It can press on the Optic Nerves

Treat with:
Bromocriptine
Cabergoline

(Dopamine Agonists that will shrink the tumor!!)