Chapter 35

Hypothalamic and Pituitary Agents

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Hypothalamic Releasing Factors With
Diagnostic Functions
• CRH
– Stimulates release of ACTH from anterior
pituitary
– Used to diagnose Cushing’s disease
• Gonadorelin (Factrel)
– GnRH analog
– Checks for anterior pituitary response and
gonadotropin deficiency
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 Hypothalamic Releasing Factors With
Diagnostic Functions (cont.)

• TRH (Protirelin)

– Stimulates the pituitary to produce thyrotropin,

which stimulates the thyroid to produce thyroid
hormones

• GHRH (Sermorelin)

– Stimulates the production of growth hormone

(GH) by the anterior pituitary

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Hypothalamic Releasing Factors Used to
Treat Diseases and Their Actions
• Goserelin (Zoladex)
– Analog of GnRH; inhibits pituitary gonadotropin
secretion with a resultant drop in the production
of the sex hormones
• Histrelin (Supprelin), ganirelix (Antagon), and
abarelix (Plenaxis)
– GnRH agonists; inhibit gonadotropin secretion
and decrease the levels of steroid sex hormones

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Hypothalamic Releasing Factors Used to
Treat Diseases and Their Actions (cont.)
• Leuprolide (Lupron)

– Occupies pituitary GnRH receptor sites so that

they no longer respond to GnRH

• Nafarelin (Synarel)

– A potent agonist of GnRH; decreases

production of gonadal hormones by repeated
stimulation of their receptor sites

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Site of Action of Hypothalamic and
Pituitary Agents

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 Anterior Pituitary Hormones and
Their Indications
• Chorionic gonadotropin (Chorex): treats
hypogonadism, ovulation, and prepubertal
cryptorchidism
• Corticotropin (Acthar) or ACTH: tests adrenal function
and responsiveness
• Cosyntropin (Cortrosyn): diagnoses adrenal
dysfunction
• Menotropins (Pergonal): fertility drug
• Somatropin (Nutropin, etc.): treats growth failure,
Turner’s syndrome, AIDS, growth hormone deficiency
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Anterior Pituitary Hormones and Their
Indications (cont.)

• Somatropin rDNA origin (Zorbtive): treats short

bowel syndrome

• Thyrotropin (Thytropar): diagnostic agent to

evaluate thyroid function

• Somatrem (Protropin): treats children with

growth failure

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 Anterior Pituitary Hormones
• Action
– Somatropin is a hormone of recombinant DNA
origin that is equivalent to human growth hormone
• Indication
– Treatment of failure of growth due to lack of growth
hormone
• Pharmacokinetics
– Injected and reaches peak in 7 hours
– Widely distributed in the body
– Excreted through the urine and feces
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Anterior Pituitary Hormones (cont.)

• Contraindications

– Known allergy

– Allergy to ingredients in the drug

– Presence of closed epiphyses

– Underlying cranial lesions

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Anterior Pituitary Hormones (cont.)

• Adverse reactions

– Inflammation

– Swelling and joint pain

– Hypothyroidism and insulin resistance

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 Growth Hormone Antagonists
• Actions
– Is an inhibitory factor released from the
hypothalamus
– It is not used to decrease GH
– It has multiple effects on many of the secretory
systems
• Indication
– Treatment of acromegaly
• Pharmacokinetics
– Vary depending on the drug
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Growth Hormone Antagonists (cont.)

• Contraindications
– Known allergy
• Caution
– Pregnancy and lactation
– Presence of any other endocrine disorder
• Adverse reactions
– Vary with each medication

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 Posterior Pituitary Hormones
• Indications
– Treatment of neurogenic diabetes insipidus
– Desmopressin is also indicated for the treatment
of hemophilia A and von Willebrand’s disease
– Nocturnal enuresis
• Pharmacokinetics
– Rapidly absorbed and metabolized
– Excreted in the liver and kidneys
– Not used during pregnancy due to the risk of
uterine contractions
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Posterior Pituitary Hormones (cont.)
• Contraindications
– Known allergy
– Severe renal dysfunction
• Caution
– Known vascular disease
– Epilepsy
– Asthma
– Pregnancy
– Lactation
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Posterior Pituitary Hormones (cont.)

• Adverse reactions

– Water intoxication

– Related to the shift in water retention

– Stimulation of the GI tract

– Local nasal irritation

– Hypersensitivity

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Use of Hypothalamic and Pituitary Agents
Across the Lifespan

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Prototype Hypothalamic Releasing Factors

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Prototype Anterior Pituitary Hormones—
Growth Hormone

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Prototype Posterior Pituitary Hormones

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 Nursing Considerations for Anterior
Pituitary Hormones—Growth Hormone

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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Nursing Considerations for Posterior
Pituitary Hormones

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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