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37 Cards in this Set
- Front
- Back
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CRH is secreted by the hypothalamus to the corticotrophs of the anterior pituitary gland. It then secretes ACTH to the adrenal cortex which secretes Glucocorticoids and Mineralocorticoids.
What potentiates CRH? |
ADH
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What factors stimulate CRH secretion?
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Stress
Hypoglycemia Cold exposure Pain |
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Why would hypoadrenalism cause changes in skin pigmentation?
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There are high structural similarities between Melanocyte stimulating hormone and ACTH
Hypoadrenalism --> High ACTH --> Skin pigmentation |
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What are the effects of ACTH?
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It directly and indirectly acts as anti-inflammatory
High levels cause adrenal hyperplasia Low levels as seen with chronic glucocorticoid administration cause adrenal atrophy |
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What hormone do you look for if you are assessing adrenal function?
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Cortisol early in the morning
ACTH fluctuates in a pulsatile manner and is not representative. |
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If you are looking for a cortisol excess, when do you look at levels?
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At midnight, when it is lowest
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A patient is diagnosed with hypercortisolism. If the disorder is primary, what will be the effect of CRH?
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No effect
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If the disorder is secondary, what will the effect of CRH be?
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It will give an acute rise in ACTH and Cortisol
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If the disorder is an ectopic tumor, what will the effect of CRH be?
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No effect
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How is adrenal insufficiency diagnosed?
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Give synthetic ACTH
Cosyntropin Tetracosactide |
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What is the recommended therapy for adrenal insufficiency?
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Cortisol analogues
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A patient diagnosed with adrenal insufficiency is given cosyntropin. What effect will this have?
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It will have no effect because the adrenal gland is unresponsive.
This is why ACTH is not a recommended therapy. Use Cortisol instead |
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What receptor does GnRH work through?
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Gq - PLC, IP3, Ca++ pathway
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What are the two general types of GnRH analog? What is each of their uses?
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Short Half Life - To stimulate ovulation in women with infertility of hypothalamic origin
Long Half Life - To suppress sex hormone production |
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Name the four GnRH agonists.
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Leuprolide
Histrelin Naferelin Goserelin |
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What are these drugs indicated for?
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Endometriosis
Uterine Fibroids Children with precocious puberty Androgen dependent breast/prostate cancer |
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What is a drawback of these drugs?
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They can cause a transient flare in sex hormone levels and therefore shouldn't be used in advanced cases of androgen dependent breast/prostate cancer
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Name the 3 GnRH antagonists and their indications
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Abrelix - For advanced breast/prostate cancer
Cetrorelix, Ganirelix - Control ovarian stimulation |
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What is especially notable about Abrelix?
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Can prolong the QT interval
Avoid co-administration with other drugs that do this. |
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T/F - Long Half Life GnRH agonist and GnRH antagonists have similar effects in terms of Gonadotropin hormone suppression.
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True
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What is the function of LH and FSH in males?
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LH - Stimulates androgen synthesis
FSH - Stimulates sperm production |
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What is the function of LH and FSH in females?
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LH -Induces ovulation and progesterone synthesis
FSH -Stimulates estrogen synthesis and promotes follicle growth |
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Name the two FSH analogues.
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Urifollitropin
Follitropin |
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What are they indicated for?
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Stimulation of ovulation in in vitro fertilization
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What is the most prominent side effect?
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May cause OHS (Ovarian Hyperstimulation Syndrome)
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In addition to Estrogen, Progesterone and testosterone, the gonads secrete two more hormones. What are they and what are their effects?
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Activin - Secreted from ovaries. Stimulate FSH secretion
Inhibin - Secreted from testes. Inhibits FSH secretion |
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In men, testosterone inhibits LH, FSH secretion. How does feedback inhibition work in women?
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Low levels of estradiol and progesterone inhibit FSH and LH
High sustained levels of estradiol as in the late stages of follicle development, increase FSH and LH secretion. |
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What two hormones are secreted by the posterior pituitary gland?
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ADH and Oxytocin
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What are the two ADH receptors and their signaling effects?
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VR1 - Vascular system at high concentrations
VR2 - Kidney - main effect |
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They hypothalamus has osmoreceptors that sense when blood pressure it decreased. It then synthesizes ADH and secretes it via the posterior pituitary. When does this occur?
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Only in severe situations (15%-20% reduction in blood volume)
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ADH is considered to be this type of hormone.
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Posterior Pituitary hormone, even though it is synthesized in the hypothalamus
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In SIADH, the first line of therapy is to get rid of the tumor that is producing the excessive ADH.
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Secondary therapy is to administer an ADH antagonist.
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What is Diabetes Insipidus?
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Either the inability of the hypothalamus to synthesize ADH or the unresponsiveness of the kidneys to ADH. Polyuria, Polydipsia, thirst
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What is the therapy for neurogenic diabetes insipidus? Nephrogenic diabetes insipidus?
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ADH analogues
Restrict fluid intake - no pharmacologic therapy available |
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In both SAIDH and Diabetes Insipidus, therapy includes restricting water intake. Why?
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In Diabetes Insipidus, you want to avoid excessive urine dilution which would cause too much solute flow into the tubules.
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What are the two main functions of oxytocin?
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Uterus - stimulates contraction
Breast - Contraction of myoepithelial cell surrounding the alveoli to induce milk secretion |
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Estrogen enhances oxytocin receptor expression and is secreted more during late pregnancy.
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Progesterone inhibits oxytocin receptor expression and is expressed less in late pregnancy.
High doses of oxytocin may cause ADH like effects because of their structural similarities. |
