1Three classes of drug treatments for acromegaly
dopamine agonists, somatostatin analogs, GH receptor antagonists
2What are the dopamine agonists used for acromegaly?
bromocriptine, cabergoline
3What are the somatostatin analogs used for acromegaly?
ocreotide, lanreotide, pasireotide
4What are the GH receptor antagonists used for acromegaly?
pegvisomant
5What is important to know about dopamine receptor agonists?
They inhibit GH secretion in patients with acromegaly, but are fairly ineffective. Reduces GH in about 20% of patients and normalizes IGF-1 in just 10%. However, they are cheap and have relatively little side effects, so good choice for some patients.
6What is important to know about somatostatin anologues?
Somatostatin (GHIH) inhibits production of GH. These anologues provide a similar function but are more potent. Effective in 50-60% of patients, but can cause both hypo and hyperglycemia, and can increase LFTs and QTc. Octreotide is short acting and not as useful, the other are long acting.
7What is important to know about GH receptor antagonists?
Very effective, but does nothing to slow tumor growth or production of GH. While GH action is blocked, it still may worsen cases of tumor growth, and increase LFTs. 97% effective.
8What is important to know about recombinant growth hormone (somatropin)
Used to treat dwarfism, dose needed decreases with age. May cause hyperglycemia and diabetes. Can also cause idiopathic intracrania hypertension, high pressure in area surrounding brain and spinal cord, and cause intracranial tumors.
9What is important to know about recombinant IGF-1 (mecasermin [increlex])?
Also used to treat dwarfism, useful in patients with GH resistance, but not as effective as recombinant growth hormone. SQ injection BID. Can causes hypoglycemia, and hypertophy.
10What is central diabetes insipidus?
When the pituitary gland doesnt release enough ADH, the kidneys will produce large amounts of urine.
11What is nephrogenic diabetes insipidus?
When the pituitary gland makes appropriate levels of ADH, but the kidneys don't respond properly and still produce large amounts of urine.
12What can be used to treat central diabetes insipidus?
Desmopressin, may cause water toxicity or hyponatremia, and increase blood pressure. Avoid in patients where fluid/electrolyte imbalances are possible.
13What is SIADH?
When there is too high vasopressin activity, leading to low urine volume and high osmolality.
14What drugs can cause SIADH?
antipsychotics, antidepressants, anticonvulsants, thiazide diuretics, ACEIs, NSAIDs, acetaminophen, opioids, anticancer agents, ecstacy.
15Where is the zona glomerulosa located and what does it produce?
It is the top layer of the adrenal gland and produces mineralcorticoids
16Where is the zona fasciculata located and what does it produce?
it is the middle layer of the adrenal gland and produces glucocorticoids
17Where is the zona reticularis located and what does it produce?
it is the bottom layer and produces androgens
18What is mitotane
Steroidogenesis inhibitor, remains in adipose tissue for years so avoid in patients who want to become pregnant, pregnancy category x
19What steroidogenesis inhibitor is ideal for females?
Ketoconazole
20What steroidogenesis inhibitor is ideal for males?
Metyrapone and Osilodrostat
21Equivalent potency of cortisone
25mg
22equivalent potency of hydrocortisone
20mg
23equivalent potency of prednisone
5mg
24equivalent potency of prednisolone
5mg
25equivalent potency of triamcinolone
4mg
26equivalent potency of methylprednisolone
4mg
27equivalent potency of betamethasone
0.6mg
28equivalent potency of dexamethasone
0.75mg