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36 Cards in this Set

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Releasing Hormones:
- GHRH: growth hormone
- TRH: Thyrotropin
- Corticotropin: CRH
- Gonadotropin: GnRH
- LRH (luteinzing )
Inhibitory Hormones:
- GHIH, somatostatin
- Prolactin inhibitory hormone (PIH, dopamine)
Anterior Pituitary Hormones:
- GH
- Thyroid Stimulating Hormone (TSH)
- Adrenocorticotropic hormone (ACTH)
- Follicle Stimulating Hormone (FSH)
- Thyroid STimulating Hormone (TSH)
- Adrenocorticotropic Hormone (ACTH)
- Prolactin
- Luteinzing Hormone (LH)
Posterior Pituitary Hormone:
Oxytocin and Vasopressin
Growth Hormone Releasing HOrmone:
- 1-29 amino terminal seg.
- stimulates synthesis and release of GH from the hypothalamus.
- Receptor Coupled w/ Gs protein, activates adenylate cyclase
- isolated both as 40 and 44 a.a. peptide.
Sermorelin (GEREF): I.V. TX.
- acetate salt of synthetic 29 a.a. peptide that is amino terminal seg. of GHRH.
- USE: IDOPATHIC GH deficiency --> NOT WORK.in pt. whose GH deficiency results from DEFECT IN ANTERIOR PITUITARY.
Somatostatin (GHIH)
- 14 a.a.
- inhibits GH release.
- Can inhibit release of INSULIN, GLUCAGON, GASTRIN.
- Produce numerous actions and has short half-life.
OCTREOTIDE (Somatostatin)
- 8 a.a. synthetic analog of somatostatin.
- long half-life
- 45x INHIBITING GH release
- 2x reducing insulin secretion.
Octreotide use:
Acromegaly:
- arthropathy
- carpal tunnel syndrome
- visceromegaly
- HTN
- glucose intolerance
- ha.
- lethargy
- sleep apnea
- excess perspiration.
Adverse Effects of Octreotide:
- Nausea
- Diarrhea
- Abdominal pain (all 50%)
- BILIARY SLUDGE
- GALLSTONE (ALL 25%)
What is the inf. susp called?
octreotide acetate --> Sandostatin (LAR)
GH (Somatropin: Serostim)

191 a.a. PEPTIDE
MOA: DIRECT:

1. INCREASE LIPOLYSIS IN ADIPOCYTES, STIMULATES GLUCONEOGENSIS IN HEPATOCYTES.

INDIRECT:

1. ANABOLIC and growth promoting effects through induction of IGF , IGF, IGF, (SOMATOMEDINS)

GH stimulates the synthesis of somatomedins:
1. Uptake of glucose
2. Uptake of a.a.
3. decreased lipolysis
4. bone and cartilage growth.
IGF
1 AND 2

mostly it is IGF-1 made in the LIVER.
- more dependent on GH and appears to be principal mediator.
Indications of GH
1. GH deficiency in children (deficiency - congenital or acquired)
2. Children w/ chronic renal insufficiency.
3. Girls w/ Turner's Syndrome
4. Adults with GH deficiency.
Adverse Effects of GH in children and adults:
Children:
1. intracranial HTN
2. HA, N/V.
3. Visual disturbances.

Adults:
1. Peripheal edema
2. Carpal tunnel syndrome
3. Myalgia
4. Arthralgia
5. Hypoglycemia.
Pegvisomant (Somavert)
GH antagonist
- used in acromegaly.

Adverse effect:
1. Tumor growth
2. Elevated Liver enzymes
Thyrotropin alpha (rhTSH)
Thyroid Stimulating Hormone (TSH)
Released from hypothalamus.
PROTIRELIN (Thyrotropin releasing hormone )
- causes anterior pituitary to release TSH.
- TSH stimulates thyroid to T4 T3,thyroglobulin.
What can be used for diagnosis of THYROID function?
- Protirelin (thyrotropin releasing hormone)
Thyrotropin alpha (rhTSH) THYROGEN
RECOMBINANT TECHNOLOGY
- binds to TSH
- STIMULATES: adenylyl cyclase activity --> increase cAMP...increases iodine uptake and increased production of thyroid hormones.
Uses of rhTSH
W/ I 131 -> treat metastatic diff. thyroid cancer in presence of high serum TSH.

- determination of follow-up after total thyroidectomy (
Adverse efects
- ASTHENIA
- n/ha.
Adrenocorticotropic Hormone (ACTH)
- released by CRH.
- STIMUATES production of glucocorticods, mineralcorticoids, adrenal androgens.
- AMINO TERMINAL PORTION CONTAINING A.A. 1-24 NECESS. FOR full biological activity.
Synthetic ACTH 1-24:
- Cosyntropin.
Diagnostic uses: ADRENAL INSUFFICIENCY
- ACTH (COSYNTROPIN)
Sustained non-pulsatile manner of GnRH inhibits:
release of FSH and LH in men and women --> causes DOWN REGULATION AND DESENTIZATION OF GnRH receptors.
Gonadorelin HCl (FACTREL)
USES:
1. (DIAGNOSIS) To distingush b/w consititutional delay in puberty and hypogonadotropic hypogonadism (diagnosis)
2. Reproductive disorders secondory to GnRH deficiency or disordered secretion of GnRH --> pulsatile adm.
Adverse Effects of GONADORELIN:
- HA
- LIGHT-HEADNESS
- N
- FLUSHING
- LOCAL SWELLING
- GENERALIZED hypersenitivity reactions after long-term SC adm.
GnRH agonists should CONTINUOUSLY be given to:
- Prostate Cancer
- Uterine Fibroid
- Endometriosis
- Precocious Puberty
- In vitro fertization.
GnRH agonist
Leuprolide (LUPRON)
Nafarelin (SYNAREL)
Goserelin (ZOLADEX)--implant
Indication for GnRH agonist:
1. Leuprolide (LUPRON)
- Endometrosis
- Uterine fibriod
- Prostate cancer
- Central precocious puberty

2. Nafarelin (SYNAREL)
- Endometrosis
- Central precocius puberty
- Uterine Fibroids

3. Goserelin (Zoladex) implant:
- Endometrosis
- Prostate Cancer
- Dysfunctional uterine bleeding
- Breast Cancer.
Common S/E of GnRH agonist in WOMEN
- HOT FLUSHES, SWEATS, HA.
- Rhinitis (for Nafarelin)
- Ovarian cysts, osteoporsis, elevated cholestrol and TG.
Common S/E of GnRH agonist in MEN:
- Flushes and sweats
- edema
- Increases testertone (bone metastasis)
- Vertebral metastasis
- Worsens urinary obstruction
- Gynecomastia
- Decreased Libido/hematocrit
- Asthenia
Contraindications w/ GnRH agonist:
- Breast Feeding
- Pregnancy

Nasal decongestants not good with Nafarelin (synarel)
Gonadotropins:
FSH
LH
FSH: WOMEN:
1. GAMETOGENSIS and follicular development.

MEN: Spermatogensis -> stimulates production of androgen - binding protein.
LH affects women and men:
Women: LH stimulate follicular growth (in concert with FSH)
1. INDUCES ovulation
2. Stimulates corpus luteum to produce progesterone and andrognes.

MEN: acts on testicular LEYDIG CELLS to stimulate testosterone production.