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Hypothalamic and Pituitary Agents
Hypothalamic and Pituitary Agents
Chapter 35
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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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
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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
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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
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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
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Site of Action of Hypothalamic and Pituitary Agents
Site of Action of Hypothalamic and Pituitary Agents
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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
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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
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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
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Anterior Pituitary Hormones (cont.) Anterior Pituitary Hormones (cont.)
• Contraindications
– Known allergy
– Allergy to ingredients in the drug
– Presence of closed epiphyses
– Underlying cranial lesions
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Anterior Pituitary Hormones (cont.)Anterior Pituitary Hormones (cont.)
• Adverse Reactions
– Inflammation
– Swelling and joint pain
– Hypothyroidism and insulin resistance
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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.
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AnswerAnswer
True
Rationale: Somatropin replaces human growth hormone; stimulates skeletal growth, growth of internal organs, and
protein synthesis.
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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
• Pharmacokinetics
– Varies depending on the drug
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Growth Hormone Antagonists (cont.)Growth Hormone Antagonists (cont.)
• Contraindications
– Known allergy
• Caution
– Pregnancy or lactation
– Presence of any other endocrine disorder
• Adverse Reactions
– Varies with each medication
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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
• Pharmacokinetics
– Rapidly absorbed and metabolized
– Excreted in the liver and kidneys
– Not used during pregnancy due to the risk of uterine contractions
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Posterior Pituitary Hormones (cont.)Posterior Pituitary Hormones (cont.)
• Contraindications
– Known allergy
– Severe renal dysfunction
• Caution
– Known vascular disease
– Epilepsy
– Asthma
– Pregnancy
– Lactation
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Posterior Pituitary Hormones (cont.)Posterior Pituitary Hormones (cont.)
• Adverse Reactions
– Water intoxication
• Related to the shift in water retention
– Stimulation of GI tract
– Local nasal irritation
– Hypersensitivity
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Use of Hypothalamic and Pituitary Agents Across the Lifespan
Use of Hypothalamic and Pituitary Agents Across the Lifespan
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Prototype Hypothalamic Releasing Factors
Prototype Hypothalamic Releasing Factors
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Prototype Hypothalamic Releasing Factors (Contiuned)
Prototype Hypothalamic Releasing Factors (Contiuned)
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Prototype Anterior Pituitary Hormones – Growth Hormone, Agonist
Prototype Anterior Pituitary Hormones – Growth Hormone, Agonist
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Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist
Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist
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Prototype Anterior Pituitary Hormones – Growth Hormone, Antagonist (Continued)Prototype Anterior Pituitary Hormones –
Growth Hormone, Antagonist (Continued)
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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
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Nursing Considerations for Posterior Pituitary Hormones
Nursing Considerations for Posterior Pituitary Hormones
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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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
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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.