Hypothalamus and Pituitary

Question 1

Hormones released from the anterior pituitary do what?

Answer 1

stimulate the production of hormones by a peripheral endocrine gland, the liver, or other tissues

Question 2

Hormones released from the posterior pituitary act how?

Answer 2

act directly on target tissues

Question 3

what do hypothalamic factors do?

Answer 3

regulate the release of anterior pituitary hormones

Question 4

what are the positive and negative feedback hypothalamic hormones affecting Growth hormone?

Answer 4

positive: Growth hormone releasing hormone
negative: somatostatin

Question 5

what are the functions of growth hormone? (3)

Answer 5

Required for normal growth

Regulates lipid and carbohydrate metabolism and lean body mass

Regulates production of insulin-like growth factor 1 (IGF-1) in peripheral tissues

Question 6

what is Somatropin?

Answer 6

recombinant form of Human growth hormone

Question 7

what are some indications for use of somatropin?

Answer 7

• short stature
• failure to thrive
• small-for-gestational-age
• HIV wasting
• short bowel syndrome= improves GI function

Question 8

Adverse effects of Somatropin in children?

Answer 8

• pseudotumor cerebri
• slipped capital femoral epiphysis
• progression of scoliosis
• hyperglycemia

Question 9

If given glucocorticoids in addition to GH, what might you find?

Answer 9

it may inhibit the growth-promoting effects of GH

Question 10

If you give GH in addition to other hormones, what might happen?

Answer 10

may accelerate epiphyseal closure and compromise final height

Question 11

what is mecasermin?

Answer 11

recombinant human IGF-1

Question 12

when do you use mecasermin?

Answer 12

children w/ growth failure unresponsive to GH therapy and are deficient in IGF-1

Question 13

ADE of mecasermin?

Answer 13

• hypoglycemia
• tonsillar/adenoidal hypertrophy, lymphoid hypertrophy
• coursing facial features

Question 14

what are the dopamine agonists?

Answer 14

bromocriptine

cabergoline

Question 15

what are GH antagonists?

Answer 15

Octreotide, Lanreotide, Pasireotide

Pegvisomant

Question 16

If a pt has a growth hormone-secreting pituitary adenoma, what is it called in adults? children?

Answer 16

adults= acromegaly
children= gigantism

Question 17

what diagnostic tool can be used to test IGF-1?

Answer 17

oral glucose tolerance test

Question 18

what would you find after giving the glucose in OGTT?

Answer 18

Oral glucose load would be expected to suppress GH concentrations
Patients with acromegaly continue to secrete GH during the OGTT

Question 19

rank the effectiveness of dopamine agonists, somatostatin analogs, and GH-receptor antagonist in lowering GH concentrations

Answer 19

(least) dopamine agonists < somatostatin analogs < GH-receptor antagonist (most)

Question 20

what happens in pts with acromegaly when using dopamine agonists?

Answer 20

paradoxical decrease in GH production

normalize IGH-1 concentrations

Question 21

Unique ADEs of dopamine agonists

Answer 21

thickening of bronchial secretions and nasal congestion

Question 22

how do somatostatin analogs work?

Answer 22

inhibit the release of GH, glucagon, insulin, and gastrin

Question 23

ADEs of somatostatin analogs

Answer 23

• Gallstones (inhibition of CCK release)
• Cardiac conduction abnormalities
• Hypertension
• Abnormalities in glucose metabolism
• Subclinical hypothyroidism

Question 24

What is Pegvisomant and how does it work?

Answer 24

GH antagonist

• Inhibits IGF-1 production
• Blocks the physiologic effects of GH on target tissues

Question 25

What is a unique ADE of pegvisomant?

Answer 25

Increased liver enzymes

Question 26

what is the primary treatment of acromegaly?

Answer 26

surgery

Question 27

Causes of hyperprolactinemia?

Answer 27

prolactin stimulators (lots of types of drugs) dopamine antagonists (mostly from antipsychotics)

Question 28

what are treatment options for hyperprolactinemia? What is most effective?

Answer 28

- dopamine agonists (more effective than surgery) - radiation therapy - transsphenoidal surgical removal of the tumor

Question 29

How do dopamine agonists work in pts w/ hyperprolactinemia?

Answer 29

Hypothalamic release of dopamine inhibits the release of prolactin

Question 30

ADE of Bromocriptine

Answer 30

infertility

Question 31

ADE of Cabergoline

Answer 31

Mild-to-moderate decreases in blood pressure

Question 32

If you lose your pituitary gland due to a tumor, what do you have? What does it require?

Answer 32

panhypopituitaryism replacement of all hormones exogenously

Question 33

What 2 hormones are released by the posterior pituitary?

Answer 33

oxytocin vasopressin

Question 34

What is used to dx TRH or TSH deficiencies?

Answer 34

Thyrotropin-releasing hormone

Question 35

What are dopamine agonists used for?

Answer 35

Tx of hyperprolactinemia

Question 36

What are GnRH analogs used for?

Answer 36

Inhibiting gonadal function in precocious puberty, transgender/gender variant, prostate CA, & in women undergoing assisted reproductive technology (ART)