When would you use Gonadotrophin-Releasing Hormone (GnRH) Analogs to INHIBIT gonadal function?
- Precocious Puberty
- Transgender/gender variant
- Prostate CA
- Women undergoing assisted reproductive technology (ART)
- Women requiring ovarian suppression
Dopamine Agonist Indications
Hyperprolactinemia
What inhibits Growth Hormone (GH)?
Somatostatin
What does GH stimulate in the primary target organs/peripheral tissue?
Insulin-like growth factor-1 (IGF-1)
What are the functions of GH?
- Required for normal growth
- Regulates lipid and carbohydrate metabolism and lean body mass
- Regulates production in peripheral tissues of IGF-1
Indications for Somatotropin (GH) in children
- Short Stature: Turner syndrome
- Failure to thrive
- Small for gestational age
Why is Somatotropin controversial in children with idiopathic short stature?
May only add 1.5-3 inches
Indications for Somatotropin (GH) in Adults
- GH deficiency
- Wasting in HIV pt’s
- Short Bowel Syndrome
Somatotropin ADE’s in Children
- Pseudotumor cerebri
- Slipped capital femoral epiphysis
- Scoliosis progression
- Hyperglycemia
What do you need to monitor in children with GH deficiency?
Deficiency of other anterior pituitary hormones
What may inhibit the growth-promoting effects of Somatotropin (recombinant GH)?
Glucocorticoids
What may accelerate epiphyseal closure and compromise the final height of children?
Concomitant administration of other hormones with Somatropin:
- Androgen
- Estrogen
- Thyroid hormones
- Anabolic steroids
List the Recombinant IGF-1
Mecasermin
Indications for Mecasermin ?
Children with growth failure unresponsive to GH therapy are deficient in IGF-1
What is imperative patient education when starting a pt’ on Mecasermin?
Must eat a snack/meal shortly before dose to avoid hypoglycemia
Other Mecasermin ADE’s
- Tonsillar/adenoidal hypertrophy
- Lymphoid hypertrophy
- Coarsening facial features
List the Dopamine Agonist
Bromocriptine
Cabergoline
Dopamine Agonist MOA in ACROMEGALY
- Paradoxical decrease in GH production
2. Normalize IGF-1 concentrations
Dopamine agonist ADE in ACROMEGALY
Thickening of bronchial secretions and nasal congestion
List the Somatostatin Analogs
- Octreotide
- Lanreotide
- Pasireotide
Somatostatin Analog MOA
Inhibit the release of:
- GH
- Glucagon
- Insulin
- Gastrin
Somatostatin Analog Clinical applications
- Acromegaly
2. Tx other neuroendocrine tumors
Somatostatin Analog ADE’s
- Gallstones
- Cardiac conduction abnormalities
- HTN
- Abnormalities in glucose metabolism
- Subclinical Hypothyroidism
List the GH antagonist
Pegvisomant
GH antagonist (Pegvisomant) MOA
- Inhibits IGF-1 production
2. Blocks the physiological effects of GH on target tissues
GH antagonist (Pegvisomant) Clinical application
Failed to achieve normalization of IGF-1 with other tx’s
GH antagonist (Pegvisomant) ADE
Increased liver enzymes
List the two selective estrogen receptor modulators (SERM)
Raloxifene
Tamoxifen
Who would selective estrogen receptor modulators (SERM) be useful in?
Men and Women w/ persistent acromegaly who are postmenopausal OR
who have had breast CA
Hyperprolactinemia etiology
- Prolactin-secreting PITUITARY tumors (prolactinoma)
2. Medications: Prolactin Stimulators OR Dopamine antagonize
What is the treatment of choice of hyperprolactinemia?
Dopamine Agonist: Bromocriptine, Cabergoline
D2-receptor agonist MOA in HYPERPROLACTINEMIA
Inhibit the release of prolactin
Bromocriptine ADE in HYPERPROLACTINEMIA
Infertility
Cabergoline ADE in HYPERPROLACTINEMIA
Mild-to-moderate decrease in BP
Define Panhypopituitarism
Complete or partial loss of pituitary function
Panhypopituitarism treatment
Will need lifelong replacement of multiple hormones (glucocorticoids, thyroid hormone, sex steroids) and constant monitoring