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Hypothalmo-pituitary hormones By Dr.Mohamed Abd AlMoneim Attia
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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.
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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
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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.
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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.
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3. GH receptor antagonist: Pegvisoment – Pegvisomant is a new GH receptor antagonist. – It is used in treatment of acromegaly.
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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.
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Gonadotropin-releasing hormone (GnRH) GnRH is secreted by the hypothalamus to stimulate release of LH and FSH from anterior pituitary.
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Posterior Pituitary Hormones Antidiuretic hormone (Vasopressin; ADH) It act on – V1 receptors → Vasoconstriction. – V2 receptors →↑ water reabsorption.
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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.
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Adverse effects: 1.Facial pallor and hypertension due to cutaneous VC. 2.Coronary spasm. 3.Uterine spasm and abdominal colic. 4.Hyponatremic convulsions.
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Oxytocin It cause milk ejection and uterine contraction. Therapeutic uses: 1.Induction and maintenance of labor. 2.Postpartum hemorrhage. 3.Milk secretion (nasal spray).
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Contraindications: 1.Fetal asphyxia. 2.Hypertension. 3.Abnormal fetal presentation 4.Prematurity 5.CPD (cephalo-pelvic disproportion) 6.May cause rupture uterus.
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14 SIADH Due to excessive secretion of ADH Drug induced SIADH: – Carbamazepine, vinca alkaloids, Chlorpropamide Drugs to manage SIADH – Demeclocycline – Conivaptan (vasopressin antagonist)
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GOOD LUCK
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