1. Hypothalmo-pituitary hormones By Dr.Mohamed Abd AlMoneim Attia

2. Growth hormone-releasing hormone (GHRH, Sermoreline) GHRH stimulate secretion of GH from anterior pituitary. Sermoline is given S.C. as a diagnostic test or to stimulate GH release in certain children with short stature.

3. Growth hormone GH GH promotes longitudinal bone growth and cartilage synthesis, through somatomedins. It can antagonize the effect of insulin. Therapeutic uses: Replacement therapy in children with GH deficiency. Adverse effects: 1.Children may develop scoliosis and increased intracranial tension. 2.Peripheral edema and carpal tunnel syndrome. 3.Gynecomastia. 4.Diabetes mellitus

4. Growth hormone antagonists 1.GH-inhibiting hormone (GHIH, Somatostatin) – It is a hormone secreted by hypothalamus (and pancreatic cell) to inhibit the secretion of GH, insulin, glucagon, and gastrin. 2.Somatostatin analogue: Octriotide – It is more potent and has longer duration than somatostatin.

5. Therapeutic uses: 1.Acromegaly. 2.Hormone – secreting tumors (e.g. insulinoma, glucogonoma, gastrinoma, etc.). 3.Bleeding esophageal varices (it cause vasoconstriction of splanchnic blood vessels). Adverse effects: 1.Biliary sludge: symptomatic gallstones after > 6 month treatment. 2.Bradycardia and conduction disturbances.

6. 3. GH receptor antagonist: Pegvisoment – Pegvisomant is a new GH receptor antagonist. – It is used in treatment of acromegaly.

7. Adrenocorticotrophic hormone (ACTH) ACTH is secreted by the pituitary to stimulate release of glucocorticoids, merinalocorticoids, and sex hormones, It also stimulates MSH → skin pigmentation. Therapeutic uses: 1.To stimulate secretion of endogenous corticosteroids. 2.Diagnostic: differentiation between 1 ry or 2 ry adrenal insufficiency.

8. Gonadotropin-releasing hormone (GnRH) GnRH is secreted by the hypothalamus to stimulate release of LH and FSH from anterior pituitary.

9. Posterior Pituitary Hormones Antidiuretic hormone (Vasopressin; ADH) It act on – V1 receptors → Vasoconstriction. – V2 receptors →↑ water reabsorption.

10. Preparations and uses: 1.Aqueous vasopressin: short acting preparation. 2.Vasopressin in oil: injected I.M. 3.Desmopressin: synthetic long acting analog given by nasal administration in: A.Diabetes insipidus (cranial type). B.Nocturnal enuresis. C.Hemophilia A: because it ↑ formation of factor VIII (unclear mechanism). 4. Glypressin: used by I.V.I. to control acute variceal bleeding.

11. Adverse effects: 1.Facial pallor and hypertension due to cutaneous VC. 2.Coronary spasm. 3.Uterine spasm and abdominal colic. 4.Hyponatremic convulsions.

12. Oxytocin It cause milk ejection and uterine contraction. Therapeutic uses: 1.Induction and maintenance of labor. 2.Postpartum hemorrhage. 3.Milk secretion (nasal spray).

13. Contraindications: 1.Fetal asphyxia. 2.Hypertension. 3.Abnormal fetal presentation 4.Prematurity 5.CPD (cephalo-pelvic disproportion) 6.May cause rupture uterus.

14. 14 SIADH Due to excessive secretion of ADH Drug induced SIADH: – Carbamazepine, vinca alkaloids, Chlorpropamide Drugs to manage SIADH – Demeclocycline – Conivaptan (vasopressin antagonist)

15. GOOD LUCK