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Endocrine

Pituitary, Thyroid, Adrenal, Diabetes

QuestionAnswer
Hypothalamus master gland, monitor changes in pH, temp, b/p, O2, osmolarity, hemostasis to stimulate hormones in the pituitary gland to release hormones
Anterior pituitary Human growth hormone-bone growth Prolactin-produce milk ACTH-adrenal cortex stimulate glucose MSH-pigmentation TSH-thyroid FSH-follicle stimulating-ovaries, ovulation, progesterone, sperm LH-lutenizing hormone, sex hormones (estrogen, testosterone)
Posterior pituitary Oxytocin, ADH
Growth hormone bone growth, anterior pit, anti-insulin effects, works at longitudinal, epiphyseal plate before puberty (r/t lots of bone cells), powerful
What is IGF-1? mediated by growth hormone, insulin-like/anti-insulin effects: increase BS, decrease glucose uptake by tissues, decrease adiposity
Would you use IGF-1 on a child missing growth hormone? No b/c it will have effects on muscle, bone, adipose, shiftn body mass from fat to more lean muscle = decrease adiposity
What would you use for children missing growth hormone? growth hormone replacement
IGF-1 is abused by what group of people? athletes
Decrease in GH result in? short stature (pre puberty) dwarfism (if severe)
GH replacement expensive, 191 AA peptide so give SQ 6-7x/wk, tolerated in children
SE of growth hormone replacement hyperglycemia, scoliosis (bone issues), growth promoting effects, tumors all at high doses
When do you stop using growth hormone replacement? when child reaches puberty b/c epiphyseal plates are closed so there will be no effects on longitudinal bone
What is the cause of hypersecretion of GH? primary adenomas, depends on age, excess GH levels
What is giantism? excess GH prior to puberty before epiphyseal plate seals
What is Acromegaly? excess GH in the adult
Treatment of hypersecretion of GH? remove tumor - consequences: deficiency in other anterior pituitary hormones, supprss GH levels (drugs)
Growth hormone antagonists used in acromegaly, Octreotide, Pegvisomant
Octreotide GH antagonists used in acromegaly, suppress GH release from anterior pit, seen in GI, helps with esophageal varices, long-acting microsphere formulation (long sustained release over a long period of time), inject into buttocks q.4wks
Pegvisomant GH receptor antagonist used in acromegaly, pegylated GH-like molecule, has polyethylene glycol to reduce clearance, improve efficacy, increase half-life, more stable
Where is pegylated also seen with? interferons
What are the two hormones produced by the thyroid gland? T4 Thyroxine: 4 molecules of iodine T3 Triiodothyronine: 3 molecules of iodine
In circulation T4 (active) is converted to? T3 active
Which molecule is the main player in thyroid? T3
T3 and T4 is produced from where and require what? produced from tyrosine require iodine (rate limiting enzyme)
What is the rate limiting enzyme for thyroid? iodine
Which thyroid hormone is made in the highest quantity? T4 thyroxine
How to suppress thyroid hormone? block synthesis of T3, T4 block iodine transporters = can't make thyroid hormone = hypothyroidism
What are the functions of thyroid hormone? increase basal metabolic rate, increase use of glucose and O2 for ATP production, stimulate synthesis of Na/K-ATPase, increased Tb (calorigenic effect), stimulates PRO synthesis & tissue growth, stimulates lipolysis, brain development for infants
Hashimoto's Thyroiditis common cause of hypothyroidism, autoimmune which thyroid is destroyed by antibodies, need life-long replacement
Thyroid hormone replacement for Hashimoto's T4 Levothyroxine T3 Liothyronine
Levothyroxine T4 stable, cheap, 7 day half-life, PO/IV/SQ
Liothyronine T3 more potent, shorter half-life 24hrs, PO/IV/SQ, high levels can cause cardiotoxicity b/c it sensitize catecholamines: tachycardia; heart is very sensitive to thyroxine, most active seen in circulation, better than T4
Side effects of thyroid hormone replacement hyperthyroidism in excess hypothyroidism in insufficient amounts
Which thyroid hormone replacement would you use to prevent cardio SE? T4 Levothyroxine
What is the cause of hypothyroidism? Hashimoto's Thyroiditis
What is the cause of hyperthyroidism? Graves disease
Graves Disease common cause of hyperthyroidism, autoimmune, thyroid stimulating antibodies (look and act like TSH receptors), need life long replacement after tumor/thyroid is removed
Treatment for Hyperthyroidism Thioamines: Methimazole, Propylthiouracil: inhibits synthesis of thyroid hormone, inhibits synthesis of T3, T4 radioactive iodine (131I): destroys thyroid thyroidectomy beta blockers (short term use)
Propylthiouracil inhibits conversion of T4 to T3, treats hyperthyroidism, thioamine, BLACK BOX WARNING FOR SEVERE HEPATITIS
Drugs used to treat hyperthyroidism Thioamines: Methimazole, Propylthiouracil good PO absorption,bioavailability, short half-life, but accumulate in thyroid = GOOD THING
Side effects of Thioamines: Methimazole, Propylthiouracil NVD, rash (most common), rare, but faal agranulocytosis
Which drug for treatment of hyperthyroidism has a black box warning sign? Propylthiouracil
Adrenal cortex has the following hormones? cortisol (glucocorticoids) and a little bit of male sex hormones: testosterone
Adrenal medulla has the following hormones? aldosterone (mineralocorticoids)
Cortisol corticosteroid produced by adrenal gland (cortex) acts via intracellular receptors in numerous steroid responsive tissues,steroid hormone, lipophilic,doesn't dissolve in blood so it gets picked up by cortisol binding globulin taken to nucleus to binds to DNA activating gene transcription
Steroid hormones testosterone, aldosterone, cortisol, estrogen, progesterone all are lipophilic, doesn't dissolve in blood/water, need a globulin to carry them to target tissues
What other hormone act on gene transcription and need a globulin for transport? aldosterone (steroid hormone) in the renal tubules to increase expression of ATPase and sodium channels
Where do globulins come from? liver
If blood sugar decrease (DM) it triggers what? release of catecholamines, glucagon, cortisol
Cortisol is used for? energy to increase BS so it is released during periods of stress
Side effects of corticosteriods if used more >2 weeks: hyperglycemia, edema, HTN, hypokalemia (mineralcorticoid effect), redistribution of fat, osteoporosis: inhibit vit. D, infection, impair wound healing, insomnia, behavioral changes (steroid rage), iatrogenic Cushing syndrome
Who receives long term corticosteroids? RA, organ transplants, severe autoimmune disease; used for treatment not an replacement
Inhibit osteoblasts and stimulate osteoclasts? corticosteroids leading to osteoporosis
Insulin replacement is used for what type of diabetes? type 1
Insulin is a peptide (PRO) so it is given by? SQ as a depot injection: bolus injection from tissue to circulation/IV
Side effects of Insulin hypoglycemia, insulin allergy: histamine release, anaphylaxis; IgG formation against insulin
Hypoglycemia can trigger what by activating what? triggers reflex hyperglycemia activates glucagon, catecholamines, cortisol
Somogyi effect hypoglycemia then pt. eats = increase BS excessively r/t activation of glucagon, cortisol, catecholamines
What meds to use to treat Type 2 DM inhibit glucose absorption increase insulin secretion (secretagogues) decrease hepatic glucose output insulin sensitizers amylin analogs, GLP-1 agonists, DPP-4 inhibitors
What are the targets of type 2 DM and where glucose comes from? liver, spleen, intestines (GUT), muscles
Alpha Glucosidase inhibitors Acarbose, Miglitol bind to intestinal brush border glucosidase (maltase, sucrose) enzymes, treat type 2 DM, slows carb absorption=decrease postpreandial spike in BG, prevents cleavage of complex carbs which facilitates glucose absorption
bind to intestinal brush border glucosidase (maltase, sucrose) enzymes, treat type 2 DM, slows carb absorption=decrease postpreandial spike in BG, prevents cleavage of complex carbs which facilitates glucose absorption Alpha Glucosidase inhibitors Acarbose, Miglitol
Side effects of Alpha Glucosidase inhibitors: Acarbose, Miglitol gas, bloating, diarrhea, abdominal discomfort, contraindicated with IBD (Crohns, UC), PUD, GERD, irritable bowel disease
Insulin secretagogues Sulfonylureas Meglitinides treat type 2 DM, inhibit K/ATP channels in beta cells leading to increase insulin release/secretion
Sulfonylureas first generation tolazamide, tolbutamide; bind K+ channels with lower affinity, higher doses required, PO, liver metabolized, safe, inexpensive
Sulfonylureas second generation glipizide, glyburide; higher affinity binding to K+ channels than 1st generation, PO, liver metabolized, safe, inexpensive
tolazamide, tolbutamide; bind K+ channels with lower affinity, higher doses required, PO, liver metabolized, safe, inexpensive Sulfonylureas first generation
glipizide, glyburide; higher affinity binding to K+ channels than 1st generation, PO, liver metabolized, safe, inexpensive Sulfonylureas second generation
treat type 2 DM, inhibit K/ATP channels in beta cells leading to increase insulin release/secretion Insulin secretagogues Sulfonylureas Meglitinides
What are the side effects of sulfonylureas? weight gain due to increased activity in adipose tissues, hypoglycemia due to oversecretion of insulin
Meglitinides Noteglinide (Starlix), Repaglinide (Prandin) treat type 2 DM, bind to same K+ channel subunit as sulfonylureas but at different site, short duration 4-7 hrs, absorption, metabolism & safety similar to sulfonylureas
treat type 2 DM, bind to same K+ channel subunit as sulfonylureas but at different site, short duration 4-7 hrs, absorption, metabolism & safety similar to sulfonylureas Meglitinides Noteglinide (Starlix), Repaglinide (Prandin)
What are Noteglinide (Starlix), Repaglinide (Prandin)? Meglitinides,treat type 2 DM, bind to same K+ channel subunit as sulfonylureas but at different site, short duration 4-7 hrs, absorption, metabolism & safety similar to sulfonylureas
Biguanides-Metformin treats type 2 DM, reduce hepatic glucose production by targeting activation of AMP-Dependent Protein Kinase (AMPPK) to inhibit hepatic gluconeogenesis & glycogenolysis; action does not depend on working Beta cells; only work on hepatocytes (liver cells)
treats type 2 DM, reduce hepatic glucose production by targeting activation of AMP-Dependent Protein Kinase (AMPPK) to inhibit hepatic gluconeogenesis & glycogenolysis; action does not depend on working Beta cells; only work on hepatocytes (liver cells) Biguanides-Metformin
Side effects of Biguanides-Metformin GI distress, impair vitamin B-12 absorption (annual screening), lactic acidosis: block the flow of metabolic acids into gluconeogenic cycles (avoid in pts w/liver disease, CHF, resp.disease, hypoxemia, severe infection, alcoholism)
Benefits of Metformin no hypoglycemia, no weight gain, lowers serum lipids, half-life 1.5-3hrs, not metabolized but excreted unchanged by kidneys, block gluconeogenesis in liver cells
What does Amylin analog Pramlintide (symlin) do? treats type 2 DM, injectable synthetic; SQ before meals, may cause hypoglycemia, N/V, appetite suppression-good b/c type 2 pts are obese and works w/hypothalamus to promote satiety (fullness)
What is amylin? a protein produced by beta cells along with insulin after a meal, suppress glucagon secretion, and delays gastric emptying
Benefits of Pramlintide (Symlin) suppress postprandial glucagon secretion from pancreas to decrease hepatic glucose output, slow gastric emptying of the stomach to allow for timely glucose absorption, enhances the felling of fullness at meals to decrease food intake
What is the amylin analog? Pramlintide (Symlin)
GLP-1 agonist Exenatide, Liraglutide synthetic analog of glucagon-like peptide-1 (first incretin hormones used therapeutically), SQ (PRO/peptide), dependent on food intake, mediated by CNS, short-lived, used in combo to improve glycemic control
What are the GLP-1 agonists? Exenatide, Liraglutide
What are incretin hormones? incretin hormones are released by GI tract in response to food intake: enhance glucose-dependent insulin release, suppress glucagon levels (glucagon raise BG)
Exenatide GLP-1 agonist, treats type 2 DM, SQ given 60 min before meals
Liraglutide GLP-1 agonist, treats type 2 DM, SQ given before meals, long half-life, once a day dosing
Benefits of GLP-1 agonists stimulates glucose-dependent insulin secretion, improves first-phase insulin response, suppress postprandial glucagon secretion, which decreases hepatic glucose production, slows gastric emptying, reduce food intake
Adverse effects of GLP-1 agonists NVD, severe pancreatitis, antibody formation
DDP-4 inhibitors: Dipeptidyl Peptidase-4 Sitagliptin, Saxagliptin, Linagliptin treat type 2 DM, inhibits DDP-4 the enzyme that degrades incretin hormones increasing levels of incretin hormone (GLP-1 and GIP); increase insulin secretion, decrease glucagon release, suppress appetite, weight loss
Benefits of DDP-4 used PO (major advantage) rare hypoglycemia approved for monotherapy can work at beta and liver cells
Adverse effects of DDP-4 increase URTI pancreatitis (sitagliptin)
What are Sitagliptin, Saxagliptin, Linagliptin? DDP-4 inhibitors
What are DDP-4 inhibitors? Sitagliptin, Saxagliptin, Linagliptin
Which DDP-4 inhibitor has an adverse effect of pancreatitis? sitagliptin
Insulin sensitizers thiazolidinediones: rosiglitazone, pioglitazone treats type 2 DM, activate PPAR-y (peroxisome proliferator-activated receptor gamma), do not affect insulin release but romote glucose and fatty acid uptake by adipocytes, increase cellular responsiveness to insulin
PPAR-y are found where? everywhere (tissues)
What are the insulin sensitizers? thiazolidinediones: rosiglitazone, pioglitazone
What are thiazolidinediones: rosiglitazone, pioglitazone? insulin sensitizers
Insulin sensitizers side effects thiazolidinediones: rosiglitazone, pioglitazone weight gain, fluid retention, MI, bone fractures
Rosiglitazone insulin sensitizer increase risk of MI, only use when all agents fail
Pioglitazone insulin sensitizer PO daily, approved for mono and combo therapy, dose-dependent risk for bladder cancer b/c PPAR-y is found everywhere
Troglitazone insulin sensitizer, removed from market r/t hepatotoxicity
Meglitinides: Repalinide (Prandin) half-life 1 hr and duration 4-7 hours
Meglitinides: Nateglinide (Starlix) half-life 1 hr and duration 4 hrs
GLP-1, DPP-4, Amylin all do what to decrease BG in type 2 DM? block glucagon that produces gluconeogenesis
Created by: cburrows