PITUITARY GLAND HORMONES HYPOTHALAMUS CONTROL

GHRHCGHReleasing Hormone ]

Growth Hormone [ GH ]

GHIHCGHInhibiting Hormone ]

Thyroid Stimulating Hormone C TSH ] TRH C Thyroid Releasing Hormone ]

Adrenocorticotropic Hormone C ACTH ] CRH C corticotropin Releasing Hormone )

Gonadotropins GnRH C Gn Releasing Hormone ]

Prolactin PIH [ Prolactin Inhibiting Hormone ]

GROWTH HORMONE INHIBITING HORMONES C GHIH ] / SOMATOSTATIN

ORGAN ACTION USES

• PITUITARY I GH Acromegalya

PANCREAS

a cells C Glucagon ] T Blood sugar

13 Celts [ Insulin ] t , Blood sugard cells C somatostatin ] I Glucagon Iletcell tumors

I Insulin

• GIT t , secretions secretory diarrhoea

• BLOOD VESSELS vasoconstriction Oesophageal varices

SOMA to statins

S Secretory diarrhea

O Oesophageal varices

M Malignancy [ Ilet cell tumors ]

A Acromegaly

→ somatostatin → Short actingOCTREOTIDE → Long acting somatostatin derivative

→ ANY PHYSIOLOGICAL SUBSTANCE ENDING iG INA IS PEPTIDE

→

They will be degraded when given by oral route

→OCTREOTIDE → given by SC route

GONADOTROPIN RELEASING HORMONE E Gn Rtl ]

PULSATILE FASHION CONTINUOUS FASHION

T Gonadotropins t , Gonadotropins

T'

Estrogen ,I progesterone I Estrogen ,

I, progesterone

T Testosterone I ,Testosterone

INDICATIONS OF GnRH

In Pulsatile manner

I Hypo gonadotropic hypogonadism2 Delayed Puberty

In continuous Fashion

I cancers

→ prostate cancer

→ Breast cancer

2 Endometriosis

3 Precocious puberty

GnRH AGONISTS

I LEUPROLIDE

2

NAFARELIN3

GOSERELIN4

BUSURELIN5 HI STAR ELIN

→ FLARE UP REACTION

→When these drugs given in continuous manner

, initial 2-3 days

there is aggravation of disease

GnRH ANTAGONISTS

I CETRO RELIX

2 GANI RELIX

3 ABA RELIX

4 DEGA RELIX

NO flare up reaction

→ but they do not Tse sex hormones

→Either GnRH Agonists or GnRH antagonists , not effective orally

PROLACTIN INHIBITING HORMONE C PIH ] I DOPAMINE [ DA ]

→ DA acts through D2 Receptors→

Drugs stimulating D2 Receptors act like PIH

→ D2 RECEPTOR AGONISTS

⇒ BROMO CRIP TINE

→ CABER LINE C Long acting ]

→INDICATIONS

I HYPER PROLACTIN E MIA

→ CABER GO LINE → DOC , can be given orally

2 PARKINSONISM

3 ACROMEGALY

→ CABERGOLINE is the preferred drug→ t , GH

→can be given orally

PEG VISONIANT [ GH RECEPTOR ANTAGONIST ]

→

PEGVISOMANT → somatotropin Antagonist

→PEG VI SONANT → causes Visual Field defect

→PEG VISOMANT

→ polyethylene Glycol → Long acting

4 TYPE 2 DM

→ BROMOCRIPTINE → t , Insulin resistance

→ SECRETS

T3

T4

CALCITONIN

T T3 4

→ shoot acting → longer acting→

more active → Less active

→ LIOTHYRONINE→

L - THYROXINE

-

only indicator → -

Doc For hypothyroidism

Myxedema coma-

Doc For myxedema coma

[ Emergency ]

PHYSIOLOGY OF THYROID HORMONE PRODUCTION

7

--

-

I ✓ Tz "

2I

-HE÷÷.:Lt •

5

+ K

4 43"

His

I Iodide C I-

] enters into thyroid Follicle by Nat I-

Sym porter2 From Follicles Iodide enters into colloid

3 In COLLOID

I-

. .oxidation

Io

. , organificatn i tyrosine

MIT

DIT

u Coupling

T3

T4

→ all the 3 reactions catalysed by Thyroid Peroxidase

→Tz , Ty stored in colloid

4 .

ISH Stimulates thyroid5 Tz , To,

released into circulation

6 Hormone reaches peripheral tissues I organs [ Liver ]

→In the blood , Tg is active but Less in quantity

Ty is abundant but not much active

7 Peripheral conversion takes place in peripheral tissues I organs [ Liver ]

>TK metabolised T3

HYPERTHYROIDISM - DRUGS #4

I NIS INHIBITORS ✓ Tz "

2 THYROID PEROXIDASE INHIBITORSI }(3 SECRETION INHIBITORS

4 PERIPHERAL CONVERSION INHIBITORSB

5 THYROID DESTROYING DRUGS+ K

43"

HNIS INHIBITORS

is

I PERCHLORATE

2 PERTECHTE NATE

3 THIOCYANATE

→ not used clinically Cioxic ]

→ cabbage is a rich source Of Thiocyanate → GOITROGEN

THYROID PEROXIDASE INHIBITORS

I CARBIMAZOLE C inactive ] 3 PROPYL THIOURACIL [ PTU ]

v

2 METHIMAZOLE C active )

→ more potent → less potent

→ →more plasma tis Less plasma tyz

→crosses placenta easily → Less crossing of Placenta

→Doc in Ist trimester pregnancy

→no action on peripheral conversos → decreases peripheral conversion

→ slow acting drugs→

on N person , stored Tz , Ty Suffice For I - 2 WKS

on hyperthyroidism , they Suffice for 3- 4 Wks

Dose increase OF these drugs Should be done after 4 WKS .

SECRETION INHIBITORS

= NAI

2 KI

3 LUGOL 'S IODINE

→ Fastest acting anti thyroid drugs

PERIPHERAL

CONVERSION INHIBITORS

I PRO PANO LOL

2 PTU

3

PREDNISOLONE

THYROID DESTROYING DRUGS [ I' 31 ]

131→ I used because

I Nati -

Sym porter is specific For Iodine intake

→ restricts I 131 to thyroid gland2 It 31 stored in colloid

,emission of radioactive rays confined

3 '

L' 31 emits p rays , have less penetrating power

CII in pregnancy→ can be given orally

→ Radioactive drugs cause Irreversible hypothyroidism , requires lifelongthyroid hormone thearapy

→ Cl 't in a 35 yrs aged patients→ All Other anti thyroid drugs cause Reversible hypothyroidism , discontinuation

OF drug suffice

→I

131e yz

→ 8 days