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Growth Hormone Agonist

ANTERIOR
PITUITARY LOBE
HORMONES

Somatotropin
a protein that stimulates linear body growth in
children and regulates cellular metabolism in both
adults and children
lipolysis
production of free fatty acids
blood glucose
Promotes positive nitrogen balance

somatropin (Humatrope)
somatrem (Protropin)

Growth Hormone Agonist

Growth Hormone Agonist

Indications

C/I

Children with GH deficiency before

ephiphyseal closure
Growth stimulation during Turners Syndrome
Treatment of cachexia
AIDS wasting
Positive nitrogen balance in patients with
severe burns
Prader-Willi Syndrome in children

Obese patients
Patients with closed epiphysis who do not
have GH deficiency
Patients with cancer

Short bowel syndrome

Growth Hormone antagonist

Growth Hormone Excess

Somatostatin

Acromegaly

Synthetic: Octreotide & Lanreotide

Pegvisomant

Long bones will not grow in adults because the

epiphyses are closed, but bones of the extremities
(hands, feet, jaw, and nose) will enlarge

Thickened skin and soft tissues

Management:
Surgery
Dopamine agonists (cabergoline & bromocriptine)
Octreotide

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Gonadotropin-releasing hormone

Gonadotropin

release of the gonadotropins

folliclestimulating hormone (FSH) and
luteinizing hormone (LH) from the
anterior pituitary

treatment of infertility
Menotropins: (human menopausal gonadotropins or hMG)
urine of postmenopausal women and contain both FSH and
LH
Urofollitropin: FSH obtained from postmenopausal women and
is devoid of LH.
Follitropin alfa and follitropin beta: human FSH from
recombinant DNA technology
Human chorionic gonadotropin (hCG): placental hormone that
is excreted in the urine of pregnant women.
Adverse effects:
Ovarian enlargement
ovarian hyperstimulation syndrome
Multiple births

Prolactin

Prolactin Inhibiting Hormones

Prolactin serum levels increase:

Dopamine: increase growth hormones

among individuals; inhibits growth
hormone among acromegalics
Cabergoline
Bromocriptine

during pregnancy and breast-feeding

During & after sleep starts (episodic
during thee day)
during stress

normal range of serum prolactin

1 to 20 ng/mL

dopamine agonist
inhibits prolactin release
treatment of hyperprolactinemia

POSTERIOR PITUITARY LOBE

HORMONES
Oxytocin
uterine contraction (induces labor, prevents
post- partum hemorrhage)
milk ejection

Vasopressin / Anti-Diuretic Hormone

(ADH), Desmopressin
acts on the collecting tubule H2O
resorption
treatment of diabetes insipidus (DI)

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Anatomy of the Adrenal Cortex

adrenal cortex concentric zones
zona glomerulosa (aldosterone
production)
zona fasciculata (glucocorticoids)
zona reticularis (adrenal androgens)

Rowel P. Catchillar, MS

ACTIONS OF THE CORTICOSTEROIDS

ACTIONS OF THE CORTICOSTEROIDS

Adrenal corticosteroids exert effects on

almost every organ in the body
essential for homeostasis, for coping
with stress, and for the very
maintenance of life

Carbohydrate, Protein, and Fat

Metabolism

ACTIONS OF THE CORTICOSTEROIDS

ACTIONS OF THE CORTICOSTEROIDS

Electrolyte and Water Metabolism

Cardiovascular Function

Na retention = K Depletion
Ca excretion

blood glucose
protein catabolism (negative nitrogen
balance)
lipid catabolism (ketosis)

cardiac output
potentiate the responses of vascular
smooth muscle to the pressor effects of
catecholamines

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ACTIONS OF THE CORTICOSTEROIDS

ACTIONS OF THE CORTICOSTEROIDS

Immune and Defense Mechanisms

Other Endocrine Organs

inflammatory and immunological

responses constitute the basis for their
therapeutic efficacy
promote apoptosis and reduce survival,
differentiation, and proliferation of a
variety of inflammatory cells, including T
lymphocytes and macrophages

suppressive actions on certain endocrine

systems
inhibit thyroid-stimulating hormone
anticalcemic (amplification of the actions
of parathyroid hormone)
attenuation of luteinizing hormone
secretion

ADVERSE EFFECTS

ADVERSE EFFECTS

Osteoporosis (most damaging effect of

long term corticosteroids).
Glucocorticoid administration is the
most common cause of drug-induced
osteoporosis

The Infectious Process

Bisphosphonates
Calcitonin: inhibits bone resorption

heightened susceptibility to serious bacterial,

viral, and fungal infections
Local infections may reactivate and spread,
and infections acquired during the course of
therapy may become more severe and even
more difficult to recognize
increase risk of wound infection, and delay
healing of open wounds

ADVERSE EFFECTS

ADVERSE EFFECTS

Effects on Gastric Mucosa

Central Nervous System Effects

formation of peptic ulcers, with hemorrhage

or perforation or reactivation of a healed
ulcer

Hyperglycemic Action
Ophthalmic Effects
Cataract formation (especially if patient has
RA)
increase in intraocular pressure

Psychiatric side effects induced by

glucocorticoids may include mania,
depression, or mood disturbances

Fluid and Electrolyte Disturbances

retain sodium and water during steroid
therapy

Pseudorheumatism

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Additional Effects

Withdrawal

acne, striae, truncal obesity, deposition

of fat in the cheeks (moon face) and
upper part of the back (buffalo hump),
and dysmenorrhea
AIDS + glucocorticoids: Kaposis
sarcoma becomes activated or
progresses more rapidly

Glucocorticoids are not withdrawn abruptly

but are tapered. The doses are altered so
that the condition being treated will not
flare up and recovery of the hypothalamic
pituitary axis will be facilitated. Tapering
the dose may reduce the potential for the
development of Addison-like symptoms
associated with steroid withdrawal.

THERAPEUTIC USES OF STEROID

HORMONES

Replacement Therapy

Replacement Therapy
Inflammatory States
Leukemia
Shock
Congenital Adrenal Hyperplasia

Addisons disease

Inflammatory States

Shock

wide range of effects on virtually every

phase and component of the inflammatory
and immune responses
Rheumatoid arthritis is the original
condition for which anti-inflammatory
steroids were used, and they remain a
mainstay of therapy
Asthma & COPD
Guillain-Barr syndrome

Prompt intensive treatment with

corticosteroids may be lifesaving when
an excessive inflammatory reaction has
resulted in septic shock

adrenal insufficiency , Hyperpigmentation

& postural hypotension

Cortisol (20 to 30 mg/day) + 9-fluorocortisol (0.1 mg/day)

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Congenital Adrenal Hyperplasiaa

DRUGS USED IN THE DIAGNOSIS OR

TREATMENT OF ADRENOCORTICAL
ABNORMALITIES

due to 21-hydroxylase deficiency

corticotrophin secretion adrenal
hyperplasia occurs, adrenal
androgens
androgens causes virilization,
accelerated growth, and early
epiphysial fusion

Corticotropin

DRUGS USED IN THE DIAGNOSIS OR

TREATMENT OF ADRENOCORTICAL
ABNORMALITIES
Metyrapone

DRUGS USED IN THE DIAGNOSIS OR

TREATMENT OF ADRENOCORTICAL
ABNORMALITIES

differential diagnosis of both adrenocortical

insufficiency and Cushings syndrome
(hypercortisolism)
treatment of Cushings syndrome

Aminoglutethimide
competitive inhibitor of desmolase, the enzyme
that catalyzes the conversion of cholesterol to
pregnenolone
Cushings syndrome that results from adrenal
carcinoma and in congenital adrenal hyperplasia

provides enhanced amounts of all

endogenously secreted adrenocortical
hormones, including androgens

Cosyntropin
screening test to assess adrenocortical
insufficiency

Mitotane
drug of choice for the treatment of primary adrenal
carcinoma when surgery or radiation therapy is not
feasible

Ketoconazole
treatment for Cushings syndrome in patients
undergoing surgery or receiving pituitary radiation

Mifepristone (RU 486)

treatment of hypercortisolism

Dexamethasone
Large dose: diagnosis of Cushing syndrome
(Hypercoltisolism)