Kruse - Hypothalamic and pituitary hormones DSA

Question 1

Anterior pituitary hormones: GH and PRL - structure and receptors they activate

Answer 1

Structure - single chain proteins

Activate JAK/STAT activating kinase receptors

Question 2

Anterior pituitary hormones: TSH FSH, and LH - structure and receptors they activate

Answer 2

Structure - dimeric proteins

Activate GPCRs

Question 3

Anterior pituitary hormones: ACTH - structure

Answer 3

Structure - single peptide

Question 4

What inhibits TSH and TRH production?

Answer 4

T4 and T3

Question 5

What inhibits GSH, LH, and GnRH?

Answer 5

females - estrogen and progesterone

males - androgens

Question 6

What inhibits ACTH and CRH?

Answer 6

Cortisol

Question 7

What stimulates GH, what inhibits it?

Answer 7

stimulated by GHRH, inhibited by somatostatin (SST)

Question 8

What inhibits PRL production?

Answer 8

D2 dopamine receptors predominantly under inhibitory control by this means

Question 9

What stimulates PRL production?

Answer 9

TRH and hormones of glucagon family (VIP, GIP, secretin, glucagon). BUT release is predominantly under hypothalamic D2 inhibitory control.

Question 10

*** GHRH(+)/somatostatin(-) (hypothalamic hormones) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

Answer 10

GH (somatotropin) –> liver, muscle, bone, kidney (IGF-1)

Question 11

*** TRH(+) (hypothalamic hormone)—> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

Answer 11

TSH —> thyroid (T4, T3)

Question 12

*** CRH(+) (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

Answer 12

ACTH —> Adrenal cortex (GC, MC, androgens)

Question 13

*** GnRH (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

Answer 13

FSH and LH –> gonads (estrogen, progesterone, testosterone)

Question 14

*** Dopamine (hypothalamic hormone) —> ___ (ant-pit hormone) —> ___ target organ/primary target organ hormone/mediator

Answer 14

PRL —> breast

Question 15

Name of recombinant form of GH

Answer 15

somatropin

Question 16

What effect does GH have on insulin sensitivity?

What effect dos IGF-1 have on insulin sensitivity?

Answer 16

reduces it - causes mild hyperinsulinemia

GH –> JAK/STAT –> increased IGF-1 –> growth [IGF-1 increases insulin sensitivity to lower glucose]

Question 17

A child has short stature and is given something to achieve normal height. What would treatment with this drug combat in adults with the same hormonal deficient?

Answer 17

Drug: rhGH

Adults with GH deficiency have general obesity, reduced muscle mass, asthenia, reduced CO. This GH deficiency could be due to pit or hypothalamus damage.

Question 18

Syndromes, other than GH-deficiency, that rhGH can help effect stature.

Answer 18

Turner syndrome, prader willi, noonan syndrome

Question 19

AE of a child with Turner syndrome, hypothyroid, pancreatitis, gynecomastia - taking GH

Answer 19

otitis media, scoliosis, intracranial HTN (vision change, hypothyroid, nausea, vomiting)

Question 20

An adult has peripheral edema, myalgias, arthraliga, and carpal tunnel syndrome - what are these AE SE of? And what is a CI of this same drug?

Answer 20

GH

CI - malignancy

Question 21

A child has growth failure with severe IGF-1 deficiency. He does not respond to rhGH. What complex can be given?

Answer 21

Mecasermin - recombinant human IGF-1 and recombinant insulin-like GF-binding protein3 (IGFBP3)

Question 22

What should a patient taking mescasermin be instructed to do prior to taking the drug - why?

Answer 22

eat 20 minutes before administration, to avoid hypoglycemia.

Question 23

What can be used to treat ant-pit adenomas (acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, any hormone secreting tumors, etc.) that secrete GH?

Answer 23

GH-antagonists: somatostatin (SST) analogs –> Octreotide and Lanreotide

Question 24

What SST analogs are particularly approved for tx of acromegaly?

Answer 24

Lanreotide and Pegvisomant

Question 25

A person with a hormone secreting tumor is given an SST analog. What AE should be watched for?

Answer 25

- GI N/D/pain - GALLSTONES - cardiac effects (sinus brady, conduction disturbances) - B12 deficiency

Question 26

MOA of pegvisomant v. SST analogs

Answer 26

pegvisomant is a GH receptor antagonist

Question 27

A person has hyperprolactinemia (i.e. due to prolatinoma), or acromegaly or Parkinson Disease. Give what?

Answer 27

D2 Dopamine receptor agonists - bromocriptine, not cabergoline (only for hyperPRL)

Question 28

A person presents with HA, dizziness, N, fatigue, PULMONARY INFILTRATES, and possibly psychiatric manifestations. What is he/she taking?

Answer 28

Bromocriptine and cabergoline

Question 29

If a pregnant woman has a macroadenoma v. microadenoma - can she continue therapy of D2-R agonist?

Answer 29

Macroadenoma - yes, can continue. Microadenoma - no, discontinue bc microadenoma growth during pregnancy is rare

Question 30

Why are D2 agonists not recommended to suppress postpartum lactation?

Answer 30

increased risk of stroke or coronary thrombosis.

Question 31

Peptide hormone released in response to rising plasma osmolality or falling blood pressure.

Answer 31

Vasopressin and desmopressin (ADH)

Question 32

Difference between desmopressin and vasopressin.

Answer 32

``` Desmopressin = majority V2, minimal V1 activity (Kidneys) Vasopressin = V1 (CARDIAC/vasoconstrictive effects) ```

Question 33

Central DI v. nephrogenic DI will respond how to vaso/desmopressin?

Answer 33

central DI will have an effective increase in urine osmolality (problem with ADH secretion) while nephrogenic will not (problem with kidneys, not ADH)

Question 34

Vasopressin's vasoconstrictive effects means that pts with ____ should be carful when taking?

Answer 34

Coronary artery disease - due to the vasoconstriction

Question 35

A person is having seizures and hyponeatremia - this is due to what?

Answer 35

overdose of vasopressin

Question 36

A person ahs CHF or SIADH that caused euvolemin and hypervolemic hyponatremia. What drugs should be used?

Answer 36

Vasopressin antagonsists - conivaptan and tolvaptan. They increase renal free water exretion with no change in electrolyte excretion.

Question 37

Describe differences between Tolvaptan and Conivapton MOA

Answer 37

Conivaptan - V1 and V2 (nonselective) antagonists | Tolvaptan - V2 selective antagonists

Question 38

Tolvaptan and Conivapton metabolization

Answer 38

CYP3A4

Question 39

A woman presents with amenorrhea and galactorrhea. A male presents with loss of libido and infertility. What hormone are they lacking, what drug can be administered?

Answer 39

Symptomatic hyperprolactinemia - treat with D-agonists to inhibit PRL secretion

Question 40

DOC for central DI

Answer 40

desmopressin preferred, but vasopressin can also be used.