Hypothalamic-Pituitary

Question 1

When would you use Gonadotrophin-Releasing Hormone (GnRH) Analogs to INHIBIT gonadal function?

Answer 1

1. Precocious Puberty
2. Transgender/gender variant
3. Prostate CA
4. Women undergoing assisted reproductive technology (ART)
5. Women requiring ovarian suppression

Question 2

Dopamine Agonist Indications

Answer 2

Hyperprolactinemia

Question 3

What inhibits Growth Hormone (GH)?

Answer 3

Somatostatin

Question 4

What does GH stimulate in the primary target organs/peripheral tissue?

Answer 4

Insulin-like growth factor-1 (IGF-1)

Question 5

What are the functions of GH?

Answer 5

1. Required for normal growth
2. Regulates lipid and carbohydrate metabolism and lean body mass
3. Regulates production in peripheral tissues of IGF-1

Question 6

Indications for Somatotropin (GH) in children

Answer 6

1. Short Stature: Turner syndrome
2. Failure to thrive
3. Small for gestational age

Question 7

Why is Somatotropin controversial in children with idiopathic short stature?

Answer 7

May only add 1.5-3 inches

Question 8

Indications for Somatotropin (GH) in Adults

Answer 8

1. GH deficiency
2. Wasting in HIV pt’s
3. Short Bowel Syndrome

Question 9

Somatotropin ADE’s in Children

Answer 9

1. Pseudotumor cerebri
2. Slipped capital femoral epiphysis
3. Scoliosis progression
4. Hyperglycemia

Question 10

What do you need to monitor in children with GH deficiency?

Answer 10

Deficiency of other anterior pituitary hormones

Question 11

What may inhibit the growth-promoting effects of Somatotropin (recombinant GH)?

Answer 11

Glucocorticoids

Question 12

What may accelerate epiphyseal closure and compromise the final height of children?

Answer 12

Concomitant administration of other hormones with Somatropin:

1. Androgen
2. Estrogen
3. Thyroid hormones
4. Anabolic steroids

Question 13

List the Recombinant IGF-1

Answer 13

Mecasermin

Question 14

Indications for Mecasermin ?

Answer 14

Children with growth failure unresponsive to GH therapy are deficient in IGF-1

Question 15

What is imperative patient education when starting a pt’ on Mecasermin?

Answer 15

Must eat a snack/meal shortly before dose to avoid hypoglycemia

Question 16

Other Mecasermin ADE’s

Answer 16

1. Tonsillar/adenoidal hypertrophy
2. Lymphoid hypertrophy
3. Coarsening facial features

Question 17

List the Dopamine Agonist

Answer 17

Bromocriptine

Cabergoline

Question 18

Dopamine Agonist MOA in ACROMEGALY

Answer 18

1. Paradoxical decrease in GH production

2. Normalize IGF-1 concentrations

Question 19

Dopamine agonist ADE in ACROMEGALY

Answer 19

Thickening of bronchial secretions and nasal congestion

Question 20

List the Somatostatin Analogs

Answer 20

1. Octreotide
2. Lanreotide
3. Pasireotide

Question 21

Somatostatin Analog MOA

Answer 21

Inhibit the release of:

1. GH
2. Glucagon
3. Insulin
4. Gastrin

Question 22

Somatostatin Analog Clinical applications

Answer 22

1. Acromegaly

2. Tx other neuroendocrine tumors

Question 23

Somatostatin Analog ADE’s

Answer 23

1. Gallstones
2. Cardiac conduction abnormalities
3. HTN
4. Abnormalities in glucose metabolism
5. Subclinical Hypothyroidism

Question 24

List the GH antagonist

Answer 24

Pegvisomant

Question 25

GH antagonist (Pegvisomant) MOA

Answer 25

1. Inhibits IGF-1 production | 2. Blocks the physiological effects of GH on target tissues

Question 26

GH antagonist (Pegvisomant) Clinical application

Answer 26

Failed to achieve normalization of IGF-1 with other tx's

Question 27

GH antagonist (Pegvisomant) ADE

Answer 27

Increased liver enzymes

Question 28

List the two selective estrogen receptor modulators (SERM)

Answer 28

Raloxifene | Tamoxifen

Question 29

Who would selective estrogen receptor modulators (SERM) be useful in?

Answer 29

Men and Women w/ persistent acromegaly who are postmenopausal OR who have had breast CA

Question 30

Hyperprolactinemia etiology

Answer 30

1. Prolactin-secreting PITUITARY tumors (prolactinoma) | 2. Medications: Prolactin Stimulators OR Dopamine antagonize

Question 31

What is the treatment of choice of hyperprolactinemia?

Answer 31

Dopamine Agonist: Bromocriptine, Cabergoline

Question 32

D2-receptor agonist MOA in HYPERPROLACTINEMIA

Answer 32

Inhibit the release of prolactin

Question 33

Bromocriptine ADE in HYPERPROLACTINEMIA

Answer 33

Infertility

Question 34

Cabergoline ADE in HYPERPROLACTINEMIA

Answer 34

Mild-to-moderate decrease in BP

Question 35

Define Panhypopituitarism

Answer 35

Complete or partial loss of pituitary function

Question 36

Panhypopituitarism treatment

Answer 36

Will need lifelong replacement of multiple hormones (glucocorticoids, thyroid hormone, sex steroids) and constant monitoring