Physiology Block 3 Week 14 09 Growth Hormone Flashcards Preview

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Flashcards in Physiology Block 3 Week 14 09 Growth Hormone Deck (23)
1

What are the three hormones of the somatomammatropin family?

Prolactin
Growth Hormone
Human placental lactogen (hPL)

Prolactin and growth hormone have sequence homology and don't usually bind each other's recepots

hPL may have some growth hormone-like effects in the pregnant woman

2

Direct Effect of Human Growth Hormone (via insulin-like growth factor 1 [IGF1])

Primarily effects on intermediate metabolism

Direct effects on:
-adipose tissue
-liver
-muscle

3

Human Growth Hormone effect on Adipose Tissue

Decreased glucose uptake
Increased lypolysis
Decreased Adiposity

4

Human Growth Hormone effect on Liver

Increased gluconeogenesis
Increased IGF1

5

Human Growth Hormone effect on Muscle

Decreased glucose uptake
Increased AA uptake
Increase in protein synthesis
Increased lean body mass

6

Indirect effect of Human Growth Hormone

Growth promoting effects of GH are mediated by insulin-like Growth factor 1

IGF1 coordinates organ growth and linear growth rates in children

Produced by Liver

7

Human Growth Hormone effect on Bone, Heart, Lung

IGF1 from liver works on these

Increased protein synthesis
increased DNA+RNA expression
Increased cell size/number
Increased organ size
Increased organ function

8

Human Growth Hormone effect on Chondrocytes

IGF1 from liver works on this

Increased AA uptake
Increased protein synthesis
Increased DNA+RNA expression
Increased collagen
Increased cell size and number
Increased linear growth

9

Human Growth Hormone effect on Muscle

IGF1 from liver also works on this (indirect) in addition to Growth Hormone (direct)

Decreased glucose uptake
Increased AA uptake
Increase in protein synthesis
Increased lean body mass

10

Growth hormone effect on children

Infantile growth is NOT controlled by growth hormone--works through IGF1

In fetus, GH does have growth promoting effects

11

Fetal Growth Regulation

GH (direct, not thru IGFs)
IGF-1 (early); IGF-1 (late)
Epidermal and fibroblast growth factor

Maternal thyroid hormone needed in 1st trimester

12

Why is insulin important in fetal growth?

Macrosomy--Birth to large infants when mother has hyperglycemia (with uncontrolled diabetes mellitus)

Mom has high plasma glucose--crosses placenta over to the fetus

Fetus releases insulin
--the release of insulin triggers fetal growth

13

Growth Spurt

Gonadal (sex) steroids from ovaries or testes have two major effects:

-activation of the pubertal growth spurt by stimulating growth hormone release

-terminates pubertal growth spurt by inducing closure of the epiphyseal growth plates in the long bones

14

Stimulation of Growth Hormone

Amino Acids (acute):
-building new tissue

Starvation (chronic):
-counterregulatory support of blood glucose

Hypoglycemia:
-counterregulatory

Exercise:
-promoting new muscle growth

Stage 3/4 sleep:
-children with sleep deprivation often have failure to thrive

Gonadal steroids/Thyroid Hormone

15

Inhibition of Growth Hormone

Glucose, GH, IGF1 inhibit GH release via negative feedback

Cortisol:
-periods of stress limit growth to divert calories for survival

16

What test could you devise to evaluate a 3 year old child for growth hormone deficiency?

Amino Acid stimulation (Arginine Infusion)
Exercise stress test
Sleep Study and pull GH when stage 3/4 sleep

17

Growth Hormone Secretion Control

Secretion of GH is controlled by neural and hormonal input into specific hypothalamic nuclei

Stimulatory: GH-RH
Inhibitory: Somatostatin

GH stimulates target cells (liver to produce IGF-1)

IGF-1:
-directly inhibits GH release from pituitary
-inhibits GL-RH release from hypothalamus
-stimulates somatostatin release (inhibits GH release at pituitary)

GH:
-inhibits GH-RH release at hypothalamus
-GH stimulates somatostatin (inhibits GH release at pituitary)

18

Linear Growth Velocity and Weight Gain Rate from Birth to End of Puberty

Rates greatest at birth

Between 2-onset of Puberty, GH/Thyroid Hormone is necessary for normal growth rate

Female growth spurt earlier in females--estrogen

Growth spurt terminated by effect of gonadal steroids on growth plates of long bones--earlier in females

Linear growth compete by end of puberty

19

Excess Growth Hormone

What is a screening test?
What is a treatment?

Almost always due to pituitary GH-secreting tumor

Gigantism--before puberty
Acromegaly (joints on hands and feet = coarse features)--after puberty

Screening test--IGF-1 (only works when excess GH)

Treatment:
-remove tumor
-somatostatin analog--shrinks the tumor

20

Deficient Growth Hormone

What is a screening test?
What is a treatment?


Short stature--children

Adults--hypopituitary patients have GH deficiency

Screening:
-Arginine test
-exercise study
-sleep study

Treatment: Recombinant human GH injections

21

What would the effect of a somatostatin releasing tumor be?

It would lead to GH deficiency and short stature in children

22

Cushing's Syndrome effect on growth

Inhibition of GH by cortisol or glucocorticoid

Hypothalamus
-stimulates somatostatin
-inhibits GHRH release

Pituitary
-inhibits pulsatile GH release

Bone
-inhibits growth plate response to IGF-1
-inhibits collagen synthesis

Other
-inhibit GnRH/ LH-FSH/ Androgen release (men)

Ex. Gary Coleman was on prednisone (glucocorticoid analog) after kidney transplant in order to suppress immune response
--resulted in GH deficiency

23

Which of the following will lead to an increase in growth hormone secretion?

A tumor producing IGF-1

An analog of somatostatin.

An antagonist of somatostatin.

An infusion of glucose

An antagonist of somatostatin.