Ppt chapter 35-1

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Hypothalamic and Pituitary Agents

Hypothalamic and Pituitary Agents

Chapter 35


Endocrine SystemEndocrine System

• Main function is to maintain homeostasis

• Too much or too little glandular activity

– Disrupts homeostasis

– Leads to various disorders

– Interferes with the normal functioning of other endocrine glands


Hypothalamic Releasing Factors With Diagnostic Functions

Hypothalamic Releasing Factors With Diagnostic Functions

• CRH

– Stimulates release of ACTH from anterior pituitary

– Used to diagnose Cushing’s disease

• Gonadorelin (Factrel)

– GnRH analog

– Checks for anterior pituitary response and gonadotropin deficiency


Hypothalamic Releasing Factors With Diagnostic Functions (cont.)

Hypothalamic Releasing Factors With Diagnostic Functions (cont.)

• TRH (Protirelin)

– Stimulates the pituitary to produce thyrotropin, which stimulates the thyroid to produce thyroid hormones

• GHRH (Sermorelin)

– Stimulates the production of growth hormone (GH) by the anterior pituitary


Hypothalamic Releasing Factors Used to Treat Diseases and Their Actions

Hypothalamic Releasing Factors Used to Treat Diseases and Their Actions

• Goserelin (Zoladex)

– Analog of GnRH; inhibits pituitary gonadotropin secretion with a resultant drop in the production of the sex hormones

• Histrelin (Supprelin), Ganirelix (Antagon), and Abarelix (Plenaxis)

– GnRH agonists; inhibits gonadotropin secretion and decrease the levels of steroid sex hormones


Hypothalamic Releasing Factors Used to Treat Diseases and Their Actions (cont.)Hypothalamic Releasing Factors Used to Treat Diseases and Their Actions (cont.)

• Leuprolide (Lupron)

– Occupies pituitary GnRH receptor sites so that they no longer respond to GnRH

• Nafarelin (Synarel)

– A potent agonist of GnRH; decreases production of gonadal hormones by repeated stimulation of receptor sites


Site of Action of Hypothalamic and Pituitary Agents

Site of Action of Hypothalamic and Pituitary Agents


Anterior Pituitary Hormones and Their Indications

Anterior Pituitary Hormones and Their Indications

• Chorionic Gonadotropin (Chorex): Hypogonadism, ovulation, prepubertal cryptorchidism

• Corticotropin (Acthar), or ACTH: Test adrenal function and responsiveness

• Cosyntropin (Cortrosyn): Diagnose adrenal dysfunction

• Menotropins (Pergonal): Fertility drug

• Somatropin (Nutropin, etc.): Growth failure, Turner’s syndrome, AIDS, growth hormone deficiency


Anterior Pituitary Hormones and Their Indications (cont.)

Anterior Pituitary Hormones and Their Indications (cont.)

• Somatropin rDNA origin (Zorbtive): Short bowel syndrome

• Thyrotropin (Thytropar): Diagnostic agent to evaluate thyroid function

• Somatrem (Protropin): Treat children with growth failure


Anterior Pituitary HormonesAnterior Pituitary Hormones

• Actions

– Somatropin is a hormone of recombinant DNA origin that is equivalent to human growth hormone

• Indications

– Used in patients experiencing growth

• Pharmacokinetics

– Injected and reaches peak in 7 hours

– Widely distributed in the body

– Excreted through urine and feces


Anterior Pituitary Hormones (cont.) Anterior Pituitary Hormones (cont.)

• Contraindications

– Known allergy

– Allergy to ingredients in the drug

– Presence of closed epiphyses

– Underlying cranial lesions


Anterior Pituitary Hormones (cont.)Anterior Pituitary Hormones (cont.)

• Adverse Reactions

– Inflammation

– Swelling and joint pain

– Hypothyroidism and insulin resistance


QuestionQuestion

Please answer the following statement as true or false.

Somatropin is a hormone of recombinant DNA origin that is equivalent to human growth hormone.


AnswerAnswer

True

Rationale: Somatropin replaces human growth hormone; stimulates skeletal growth, growth of internal organs, and

protein synthesis.


Growth Hormone AntagonistsGrowth Hormone Antagonists

• Actions

– Is an inhibitory factor released from the hypothalamus

– Not used to decrease GH

– Has multiple effects on many of the secretory systems

• Indications

– Treatment of acromegaly


– Varies depending on the drug


Growth Hormone Antagonists (cont.)Growth Hormone Antagonists (cont.)


– Known allergy

• Caution

– Pregnancy or lactation

– Presence of any other endocrine disorder


– Varies with each medication


Posterior Pituitary HormonesPosterior Pituitary Hormones

• Indications

– Treatment of neurogenic diabetes insipidus

– Desmopressin is also indicated for the treatment of hemophilia A and von Willebrand’s disease

– Nocturnal enuresis


– Rapidly absorbed and metabolized

– Excreted in the liver and kidneys

– Not used during pregnancy due to the risk of uterine contractions


Posterior Pituitary Hormones (cont.)Posterior Pituitary Hormones (cont.)


– Known allergy

– Severe renal dysfunction

• Caution

– Known vascular disease

– Epilepsy

– Asthma

– Pregnancy

– Lactation


Posterior Pituitary Hormones (cont.)Posterior Pituitary Hormones (cont.)


– Water intoxication

• Related to the shift in water retention

– Stimulation of GI tract

– Local nasal irritation

– Hypersensitivity


Use of Hypothalamic and Pituitary Agents Across the Lifespan

Use of Hypothalamic and Pituitary Agents Across the Lifespan


Prototype Hypothalamic Releasing Factors

Prototype Hypothalamic Releasing Factors


Prototype Hypothalamic Releasing Factors (Contiuned)

Prototype Hypothalamic Releasing Factors (Contiuned)


Prototype Anterior Pituitary Hormones – Growth Hormone, Agonist

Prototype Anterior Pituitary Hormones – Growth Hormone, Agonist


Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist

Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist


Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist (Continued)Prototype Anterior Pituitary Hormones –

Growth Hormone, Antagonist (Continued)


Nursing Considerations for Anterior Pituitary Hormones – Growth Hormone

Nursing Considerations for Anterior Pituitary Hormones – Growth Hormone

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


Nursing Considerations for Posterior Pituitary Hormones

Nursing Considerations for Posterior Pituitary Hormones

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


QuestionQuestion

The nurse is caring for a 10-year-old boy with growth hormone deficiency. The child asks the nurse how long he will be able to take his medicine. Which of the following is best response?

A. Until you decide to stop

B. Until you are 13

C. Until your epiphyseal plates close

D. Until you get as tall as you want to be


AnswerAnswer

C. Until your epiphyseal plates close

Rationale: In normal growth and development growth ceases when the epiphyseal plates fuse to the ends of the long bones.

Ppt chapter 35-1

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