GH Somatropin / Somatrem

Prader-Willi syndrome
Noonans syndrome
Turner syndrome
CKD (chronic kidney disease)

IGF-1 Mecasermin
-

Used when treatment when GH is not

responding
Can cause HYPOglycemia (need to take in some CHO after
administration)

GH Antagonists (cant use Somatostatin due to short half-life)

(somatostatin = from pancreas)
1. Octreotide inhibits the release of GH
o Carcinoid syndrome (decreases serotonin release)
o WDHA (watery diarrhea/hypokalemia/achlorohydria)
o Bleeding esophageal varices (decreases portal venous pressure)

2. Pegvisomant GH hormone RECEPTOR antagonist (no effect on

GH release)
o Indication = acromegaly

Gonadotropins
Clinical uses:
1. Ovulation induction in women with anovulation due to:
o Hypogonadotropic hypogonadism (2nd hypothyroidism)
o Polycystic ovary syndrome
o Obesity
Starting from the 3rd day of the menstrual cycle, give daily FSH
for 7-12 days
2. Controlled ovarian hyper stimulation in IVF
3. Male infertility
8-12 weeks of FSH/LH/HCG to help sperm production
Toxicity:
1. Ovarian hyper stimulation syndrome
o Ovarian enlargement leads to rupture leading to:
Ascites
Hydrothorax
Hypovolemia
2. Multiple pregnancies
FSH

1. Urofollitropin / Follitropin alfa / Follitropin beta

LH

1. Lutropin

a. Female ovulation in women / formation of corpus luteum

b. Male stimulates formation of Testosterone
hCG produced by the human placenta

Oxytocin
1. Induces labor; useful in:
o Post maturity
o Health risk to mom (diabetes, preeclampsia)
o Premature rupture of membrane
2. Augment delayed labor
a. Baby that is not born by week 41
3. Control uterine hemorrhage after birth
Toxicity:

Dont give it to a pregnant person because it will cause uterine contractions

before birth. Also will cause fluid retention and water intoxication.
Contraindicated in:
-

Fetal distress / Prematurity / Cephalopelvic disproportion

Prolactin
Hyperprolactinemia can be due to DRUGS or ADEMONAs
Women amenorrhea / galactorrhea
Men decreased libido / infertility
Dopamine Agonists
- Mostly used in cases of microadenoma (<1cm). Macro-adenoma
would require surgery.
- Can cause Huntington like
symptoms

1. Bromocriptine
2. Cabergoline
3. Pergolide
Clinical:
-

These can be used in cases of prolactin secreting tumors / lower

circulating prolactin levels and restoring ovulation
Sheehans Syndrome: major hemorrhage or hypotension during the
peripartum period, can result in ischemia of the affected pituitary
regions leading to necrosis.
o Need hormone replacement with:
Prolactin
Corticosteroids

Vasopressin (ADH)
V1: vascular smooth muscle cells vasoconstriction
V2: renal tubule cells reduce diuresis
Deficiency leads to Nephrogenic Diabetes Insipidus
Central desmopressin
Nephrogenic diuretics (thiazide) = helps with loss of Na+ (balancing
blood osmolality)

Desmopressin synthetic ADH

-

Used for central diabetes insipidus

o Injection with this drug will cause >50% change in urine

osmolality (diagnosis)

Conivaptan / Tolvapatan ADH antagonists

-

Used for hyponatremia/heart

failure

Hypothalamic Hormones
(GnRH)
Natural versions of the hormone is
called Gonadorelin but its a huge
peptide and hard to administer.
1.
2.
3.
4.

Goserelin
Histrelin
Leuprolide
Naferelin

The effect of these drugs will depend on the mode of administration due to
physiological mechanisms of action:
-

Pulsatile will stimulate FSH and LH secretions (simulates normal

physiological release)
Continued inhibits release of FSH and LH

Clinical:
1. Stimulation of gonadotropin production is useful for:
o Female / Male infertility
2. Suppression of gonadotropin production is useful for:
o Assisted reproductive technologies
You dont want to do IVF & have a normal ovulation
because that increases the chance of having multiple
babies at once.
o Endometriosis (presence of endometrial tissue outside the
uterus)
Reduces estrogen and progesterone concentrations
o Uterine Leiomyoma (fibroids) reduce the size by GnRH
agonists
o Prostate Cancer
Combined antiandrogen therapy with continuous GnRH
agonist & androgen receptor antagonist
o Central Precocious Puberty when puberty occurs <8 in girls /
<9 in boys
Adverse effect:

Continuous use of GnRH analogs in women typical symptoms of

menopause
- These can be fixed by using GnRH receptor antagonists:
1. Ganirelix
2. Cetrorelix
These two drugs prevent the LH surge from occurring during controlled
ovarian hyper stimulation (for example when you are doing IVF; can be used
instead of dopamine agonists with less side effects)