Treating Acromegaly and Vasopressin Deficiency
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Questions and Answers

Which of the following is NOT a effect of growth hormone stimulation?

  • Decreased peripheral glucose utilization (correct)
  • Decreased protein catabolism
  • Increased IGF-1 release
  • Decreased insulin sensitivity

    • What can be used to test the release of growth hormone?

  • Dopamine & beta agonists
  • Obesity
  • Clonidine (correct)
  • IGF-1

    • What are the symptoms of growth hormone deficiency in adults?

  • Subcutaneous & visceral adiposity
  • Elevated LDL (correct)
  • Low bone mineral density
  • Decreased cardiac output

    • What is the goal of growth hormone therapy?

    <p>Mimic effects of endogenous GH</p> Signup and view all the answers

    What is the recommended time frame for observing the benefits of recombinant hGH replacement therapy?

    <p>3-6 months</p> Signup and view all the answers

    Which of the following is NOT an adverse effect of growth hormone therapy?

    <p>Insulin resistance</p> Signup and view all the answers

    Which hormone stimulates protein synthesis and growth?

    <p>Growth hormone (GH)</p> Signup and view all the answers

    Which hormone stimulates milk production and secretion?

    <p>Prolactin (PRL)</p> Signup and view all the answers

    Which hormone stimulates water reabsorption in principal cells of collecting ducts and arteriolar constriction?

    <p>Vasopressin</p> Signup and view all the answers

    Which hormone stimulates TSH & prolactin secretion?

    <p>Thyrotropin-releasing hormone (TRH)</p> Signup and view all the answers

    Which hormone stimulates LH/FSH secretion?

    <p>Gonadotropin-releasing hormone (GnRH)</p> Signup and view all the answers

    Which hormone inhibits growth hormone secretion?

    <p>Somatostatin</p> Signup and view all the answers

    Which drug is a weak CYP2A6 inhibitor and a weak CYP3A4 inducer?

    <p>Pasireotide</p> Signup and view all the answers

    Which drug blocks cortisol effects at the glucocorticoid receptor?

    <p>Mifepristone</p> Signup and view all the answers

    Which drug is primarily eliminated through biliary elimination as unchanged drug?

    <p>Pasireotide</p> Signup and view all the answers

    Which drug is a mineralocorticoid receptor blocker and also blocks androgen receptors?

    <p>Spironolactone</p> Signup and view all the answers

    Which drug is a selective mineralocorticoid receptor blocker without causing gynecomastia?

    <p>Eplerenone</p> Signup and view all the answers

    Which drug is a non-selective, irreversible alpha-blocker used in the treatment of pheochromocytoma?

    <p>Phenoxybenzamine</p> Signup and view all the answers

    Which medication is a first-line treatment for AVP-R and also effective in AVP-D?

    <p>Hydrochlorothiazide (HCTZ)</p> Signup and view all the answers

    Which condition is characterized by vasopressin excess and can result in rapid decreases in sodium levels?

    <p>Syndrome of Inappropriate ADH (SIADH)</p> Signup and view all the answers

    What is the treatment for SIADH to increase serum sodium levels?

    <p>All of the above</p> Signup and view all the answers

    Which medication is an oral therapy used in the treatment of Cushing's Syndrome?

    <p>Ketoconazole</p> Signup and view all the answers

    What is the mechanism of action of mitotane in the treatment of Cushing's Syndrome?

    <p>Suppresses ACTH secretion</p> Signup and view all the answers

    Which medication is approved as a diagnostic agent for ACTH dependent adrenal insufficiency and has limited availability?

    <p>Metyrapone</p> Signup and view all the answers

    Which hormone acts as an insulin sensitizer and decreases blood glucose levels?

    <p>Insulin-Like Growth Factor (IGF-1)</p> Signup and view all the answers

    What is the primary treatment for acromegaly?

    <p>Transsphenoidal surgery</p> Signup and view all the answers

    Which condition can cause gigantism in children before puberty?

    <p>GH Excess in children before puberty</p> Signup and view all the answers

    Which hormone can decrease GH production in a small percentage of acromegaly patients?

    <p>Dopamine</p> Signup and view all the answers

    Which hormone acts on V2 receptors in the collecting ducts of the kidney to increase water permeability?

    <p>Vasopressin</p> Signup and view all the answers

    Which hormone can increase water permeability in renal tubular cells to decrease urine volume?

    <p>Desmopressin (DDAVP)</p> Signup and view all the answers

    Match the growth hormone effects with their corresponding characteristics:

    <p>Stimulation of GH via GHRH = Decreased insulin sensitivity, increased IGF-1 release Inhibition of GH via somatostatin = Obesity, Dopamine &amp; beta agonists Endogenous GH release = Pulsatile Q2 hours, Diurnal Maximal secretion at night GH Deficiency = Recombinant hGH replacement, Give at night</p> Signup and view all the answers

    Match the symptoms of deficiency with the corresponding group:

    <p>Pediatrics = Short stature Adults = Elevated LDL, Low bone mineral density</p> Signup and view all the answers

    Match the goal of therapy with the corresponding treatment:

    <p>Mimic effects of endogenous GH = GH Deficiency Recombinant hGH replacement</p> Signup and view all the answers

    Match the monitoring items with the corresponding organization:

    <p>IGF-1, glucose, free T4 &amp; lipids = American Academy of Clinical Endocrinologists</p> Signup and view all the answers

    Match the adverse effects with the corresponding group:

    <p>Edema, arthralgia, myalgia, pancreatitis, insulin resistance, carpal tunnel syndrome = Most AE seen in adults</p> Signup and view all the answers

    Match the characteristics with the corresponding GH release:

    <p>Pulsatile Q2 hours, Diurnal Maximal secretion at night = Endogenous GH release Give at night, Avoid post-prandial GH elevations, Low-dose replacement preferable to higher doses = GH Deficiency Recombinant hGH replacement</p> Signup and view all the answers

    Match the following hormones with their actions:

    <p>Thyrotropin-releasing hormone (TRH) = Stimulates TSH &amp; prolactin secretion Gonadotropin-releasing hormone (GnRH) = Stimulates LH/FSH secretion Somatostatin = Inhibits growth hormone secretion Dopamine (prolactininhibiting factor) (PIF) = Inhibits prolactin secretion</p> Signup and view all the answers

    Match the following pituitary disorders with their corresponding hormone deficiencies:

    <p>Growth hormone disorders = Growth hormone Arginine vasopressin deficiency = Vasopressin Hyperprolactinemia = Prolactin Luteinizing hormone &amp; follicle stimulating hormone = Gonadotropin-releasing hormone (GnRH)</p> Signup and view all the answers

    Match the anterior pituitary hormones with their actions:

    <p>Growth hormone (GH) = Stimulates protein synthesis &amp; growth Follicle-stimulating hormone (FSH) = Stimulates estrogen synthesis &amp; follicular development Adrenocorticotropic hormone (ACTH) = Stimulates synthesis &amp; secretion of adrenal cortical hormones Thyroid-stimulating hormone (TSH) = Stimulates synthesis &amp; secretion of thyroid hormones</p> Signup and view all the answers

    Match the hypothalamic releasing hormones with their actions:

    <p>Thyrotropin-releasing hormone (TRH) = Stimulates TSH &amp; prolactin secretion Corticotropin-releasing hormone (CRH) = Stimulates ACTH secretion Gonadotropin-releasing hormone (GnRH) = Stimulates LH/FSH secretion Growth hormone releasing hormone (GHRH) = Stimulates growth hormone secretion</p> Signup and view all the answers

    Match the posterior pituitary hormones with their actions:

    <p>Oxytocin = Stimulates smooth muscle contraction Vasopressin = Stimulates Water reabsorption in principal cells of collecting ducts Antidiuretic hormone (ADH) = Stimulates Water reabsorption in principal cells of collecting ducts Arginine vasopressin (AVP) = Stimulates Water reabsorption in principal cells of collecting ducts</p> Signup and view all the answers

    Match the adrenal disorders with their corresponding hormone abnormalities:

    <p>Pheochromocytoma = Overproduction of adrenaline Cushing’s syndrome = Overproduction of cortisol Adrenal insufficiency = Underproduction of cortisol and aldosterone Hyperaldosteronism = Overproduction of aldosterone</p> Signup and view all the answers

    Match the following medical conditions with their respective treatment options:

    <p>Primary IGF-1 Deficiency = Mecasermin (Increlex®) Acromegaly = Transsphenoidal surgery, Somatostatin analogs, Pegvisomant (Somavert®), Dopamine agonists Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R) = Desmopressin (DDAVP®)</p> Signup and view all the answers

    Match the following drugs with their mechanism of action:

    <p>Mecasermin (Increlex®) = Recombinant IGF-1 administered subcutaneously Somatostatin analogs (Octreotide, Lanreotide, Pasireotide) = Inhibit GH production Pegvisomant (Somavert®) = GH receptor antagonist Dopamine agonists (Cabergoline, Bromocriptine) = Decrease GH production</p> Signup and view all the answers

    Match the following medical conditions with their diagnostic tests:

    <p>Acromegaly = CT/MRI imaging, elevated GH levels, elevated IGF-1 levels, and heel pad thickness GH Excess in children = Stimulation at the epiphyseal plates Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R) = Polyuria, nocturia, and polydipsia</p> Signup and view all the answers

    Match the following hormones with their effects:

    <p>Insulin-Like Growth Factor (IGF-1) = Acts as an insulin sensitizer and decreases blood glucose levels GH Excess = Causes bone changes, enlargement of hands and feet, insulin resistance, and neuropathies in adults Vasopressin = Increases water permeability in the collecting ducts of the kidney</p> Signup and view all the answers

    Match the following medical conditions with their symptoms:

    <p>Acromegaly = Bone changes, enlargement of hands and feet, insulin resistance, and neuropathies GH Excess in children before puberty = Gigantism due to stimulation at the epiphyseal plates Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R) = Polyuria, nocturia, and polydipsia</p> Signup and view all the answers

    Match the following drugs with their administered routes:

    <p>Mecasermin (Increlex®) = Subcutaneously Desmopressin (DDAVP®) = Orally Somatostatin analogs (Octreotide, Lanreotide, Pasireotide) = Subcutaneously or intramuscularly Pegvisomant (Somavert®) = Subcutaneously</p> Signup and view all the answers

    Match the following drugs with their primary effects:

    <p>Pasireotide (Signifor®) = Inhibits ACTH secretion Mifepristone = Blocks cortisol effects at glucocorticoid receptor Spironolactone (Aldactone®) = Blocks androgen receptors Eplerenone (Inspra™) = Selective mineralocorticoid receptor blocker</p> Signup and view all the answers

    Match the following drugs with their adverse effects:

    <p>Eplerenone (Inspra™) = Hyperkalemia Pasireotide (Signifor®) = HA, fatigue, hyperglycemia &amp; DM, GI effects, increased prothrombin time, QTc prolongation Mifepristone = Edema, HTN, fatigue, HA, dizziness, hypokalemia, nausea, vomiting, anorexia, diarrhea, arthralgias, QTc prolongation, abortifacient Spironolactone (Aldactone®) = Gynecomastia, Hyperkalemia</p> Signup and view all the answers

    Match the following drugs with their drug interactions:

    <p>Pasireotide (Signifor®) = QTc prolonging drugs Mifepristone = Corticosteroids, cyclosporine, strong CYP3A4 inducers, QTcprolonging drugs Cushing’s = Weak CYP2A6 inhibitor; weak CYP3A4 inducer</p> Signup and view all the answers

    Match the following hormones with their primary functions:

    <p>Aldosterone = Na+, H2O retention, Increased BP, Cardiac remodeling ACTH = Stimulates the adrenal glands to release cortisol GH = Stimulates growth, cell reproduction, and cell regeneration LH/FSH = Stimulates the gonads in both males and females</p> Signup and view all the answers

    Match the following conditions with their primary treatments:

    <p>Cushing’s Syndrome = Pasireotide, Mifepristone Hyperaldosteronism = Spironolactone, Eplerenone Pheochromocytoma = α-blockade to control BP; β-blocker if needed Adrenal insufficiency = Glucocorticoid replacement Hydrocortisone; Mineralocorticoid replacement Fludrocortisone</p> Signup and view all the answers

    Match the following disorders with their treatment strategies:

    <p>GH deficiency = GH replacement GH excess—acromegaly = Dopamine agonists Vasopressin deficiency (AVP-D; AVP-R) = Desmopressin (DDAVP) Hyperprolactinemia = Dopamine agonists</p> Signup and view all the answers

    Match the following treatments with the corresponding conditions:

    <p>Chlorpropamide Carbamazepine = Increase ADH response Hydrochlorothiazide (HCTZ) = 1st line in AVP-R; also effective in AVP-D IV hypertonic (3%) NaCl = SIADH treatment when Na+ very low Osilodrostat (Isturisa®) = Cushing’s Syndrome treatment when unable to have pituitary surgery</p> Signup and view all the answers

    Match the following drugs with their adverse effects:

    <p>Mitotane (Lysodren®) = N/V/D, tiredness Osilodrostat = Adrenal insufficiency, anorexia, fatigue, nausea, vomiting, electrolyte abnormalities Ketoconazole = Hepatic injury, GI effects, effects related to decreased steroid production Metyrapone (Metopirone®) = N/V, hypotension, dizziness &amp; sedation</p> Signup and view all the answers

    Match the following drugs with their mechanisms of action:

    <p>Osilodrostat (Isturisa®) = Blocks 11β-hydroxylase Ketoconazole = CYP450 enzyme inhibitor, Blocks side chain cleavage 11β-hydroxylase 17𝛼-hydroxylase 17, 20 lyase Mitotane (Lysodren®) = Cytotoxic—suppresses ACTH secretion, ↓ cortisol synthesis Metyrapone (Metopirone®) = Inhibits 11-hydroxylase, ↓synthesis of cortisol</p> Signup and view all the answers

    Match the following conditions with their descriptions:

    <p>Syndrome of Inappropriate ADH—SIADH = Vasopressin excess, Opposite of central DI, Rapid Na+ decreases can result in cerebral edema AVP-D Treatment = Increase ADH response, Inhibits renal prostaglandin synthesis, Increases ability to concentrate urine Adrenal suppression = Dose/duration dependent, Months ¯ risk &lt; 7.5-20mg pred EQ/day &lt; 3 weeks Cushing’s Syndrome = Treatment with Osilodrostat if unable to have pituitary surgery, No disease resolution after surgery</p> Signup and view all the answers

    Match the following conditions with their treatments:

    <p>SIADH = Fluid restriction – &lt; 800 mL/day, Increase solute intake – Salt tablets, urea ± loop diuretic Hyponatremia = IV hypertonic (3%) NaCl only if Na+ very low Cushing’s Syndrome = Treatment with Osilodrostat, Ketoconazole, Mitotane (Lysodren®), Cyproheptadine, Metyrapone (Metopirone®) AVP-Dependent = Increase ADH response with Chlorpropamide Carbamazepine</p> Signup and view all the answers

    Match the following conditions with their symptoms:

    <p>Hyponatremia = &gt; 130 mEq/L Asymptomatic, 120 – 125 mEq/L Lethargy, Confusion, Weakness Cushing’s Syndrome = Adverse effects from treatment with Osilodrostat include Adrenal insufficiency, anorexia, fatigue, nausea, vomiting, electrolyte abnormalities Adrenal suppression = Dose/duration &gt; 3 weeks dependent SIADH = Vasopressin excess, Rapid Na+ decreases can result in cerebral edema</p> Signup and view all the answers

    Which of the following is a stage of breast cancer according to the TNM system?

    <p>Stage 0</p> Signup and view all the answers

    Which of the following is NOT a breast cancer molecular subtype?

    <p>Estrogen Receptor Negative (ER-)</p> Signup and view all the answers

    What is the most common cause of cancer death in women after breast cancer?

    <p>Lung cancer</p> Signup and view all the answers

    Which treatment option is recommended for a 45-year-old pre-menopausal woman with invasive ductal carcinoma, grade 3, ER-, and HER2+?

    <p>Neoadjuvant chemotherapy followed by adjuvant therapy</p> Signup and view all the answers

    What is the stage of the patient's breast cancer?

    <p>IIB</p> Signup and view all the answers

    What is the recommended treatment for a post-menopausal patient with ER+/HER2+ recurrent or stage IV breast cancer?

    <p>Different endocrine therapy + HER2 targeted therapy + taxane</p> Signup and view all the answers

    What is the general approach for a breast cancer patient with metastatic disease and ER/PR-?

    <p>Chemotherapy (+/- PARP inhibitor if BRCA1 mutant)</p> Signup and view all the answers

    Which therapy is recommended as first-line treatment for high-risk patients with HER2+ breast cancer?

    <p>Trastuzumab + chemotherapy</p> Signup and view all the answers

    Which drug is indicated as adjuvant therapy for HER2+ breast cancer patients who have previously received trastuzumab and/or a taxane?

    <p>Ado Trastuzumab Emtansine</p> Signup and view all the answers

    Which drug is a dual EGFR and ErbB2 inhibitor and is approved for metastatic breast cancer treatment given in combination with capecitabine or with an aromatase inhibitor for ER+HER+ tumors?

    <p>Lapatinib</p> Signup and view all the answers

    Which drug irreversibly binds to HER receptors and is indicated as adjuvant therapy or metastatic HER2+ breast cancer, where trastuzumab has failed or is contraindicated?

    <p>Neratinib</p> Signup and view all the answers

    Which of the following is the most common cause of cancer death in women?

    <p>Lung cancer</p> Signup and view all the answers

    What is the lifetime risk of developing breast cancer for women?

    <p>1 in 8</p> Signup and view all the answers

    Which of the following is NOT a breast cancer molecular subtype?

    <p>Luminal A</p> Signup and view all the answers

    Which treatment is recommended for HER2+ metastatic breast cancer patients who have previously received trastuzumab and/or a taxane?

    <p>Ado Trastuzumab Emtansine</p> Signup and view all the answers

    What is the mechanism of action of Neratinib (Nerlynx)?

    <p>Inhibits both EGFR and ErbB2 (HER2) receptors</p> Signup and view all the answers

    Which treatment is a HER2-targeted antibody and microtubule inhibitor conjugate?

    <p>Ado Trastuzumab Emtansine</p> Signup and view all the answers

    Which treatment is recommended for ER-/HER- (PR-) breast cancer patients with T1-3 tumors and no lymph node involvement?

    <p>Adjuvant chemotherapy</p> Signup and view all the answers

    Which drug is used in combination with DNA damaging agents for metastatic disease in tumors with germline BRCA1 mutation?

    <p>Olaparib</p> Signup and view all the answers

    What is the stage of breast cancer for the 45-year-old pre-menopausal woman described in the case?

    <p>Stage IIB</p> Signup and view all the answers

    What is the recommended treatment option for the 45-year-old pre-menopausal woman with invasive ductal carcinoma, grade 3, ER-, and HER2+?

    <p>Neoadjuvant chemotherapy followed by adjuvant therapy</p> Signup and view all the answers

    What are the side effects of Olaparib (Lynparza) according to the text?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Treatment Options for Acromegaly and Vasopressin Deficiency

    • Insulin-Like Growth Factor (IGF-1) acts as an insulin sensitizer and decreases blood glucose levels.
    • Primary IGF-1 Deficiency can be treated with Mecasermin (Increlex®), a recombinant IGF-1 administered subcutaneously.
    • GH Excess in children before puberty can cause gigantism due to stimulation at the epiphyseal plates.
    • GH Excess in adults (Acromegaly) can cause bone changes, enlargement of hands and feet, insulin resistance, and neuropathies.
    • Acromegaly can be diagnosed through CT/MRI imaging, elevated GH levels, elevated IGF-1 levels, and heel pad thickness.
    • Transsphenoidal surgery is the primary treatment for acromegaly, with radiation as an adjunctive therapy in some cases.
    • Somatostatin analogs (Octreotide, Lanreotide, and Pasireotide) are used as medical therapy for acromegaly.
    • Somatostatin analogs bind to somatostatin receptors and inhibit GH production.
    • Pegvisomant (Somavert®) is a GH receptor antagonist used to treat acromegaly.
    • Dopamine agonists (Cabergoline, Bromocriptine) can decrease GH production in a small percentage of acromegaly patients.
    • Vasopressin acts on V2 receptors in the collecting ducts of the kidney to initiate an intracellular cascade and increase water permeability.
    • Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R) are conditions that affect the body's ability to concentrate urine, leading to polyuria, nocturia, and polydipsia. Treatment options include replacing fluid losses and decreasing urine output. Desmopressin (DDAVP®) can increase water permeability in renal tubular cells to decrease urine volume.

    Treatment Options for Acromegaly and Vasopressin Deficiency

    • Insulin-Like Growth Factor (IGF-1) acts as an insulin sensitizer and decreases blood glucose levels.
    • Primary IGF-1 Deficiency can be treated with Mecasermin (Increlex®), a recombinant IGF-1 administered subcutaneously.
    • GH Excess in children before puberty can cause gigantism due to stimulation at the epiphyseal plates.
    • GH Excess in adults (Acromegaly) can cause bone changes, enlargement of hands and feet, insulin resistance, and neuropathies.
    • Acromegaly can be diagnosed through CT/MRI imaging, elevated GH levels, elevated IGF-1 levels, and heel pad thickness.
    • Transsphenoidal surgery is the primary treatment for acromegaly, with radiation as an adjunctive therapy in some cases.
    • Somatostatin analogs (Octreotide, Lanreotide, and Pasireotide) are used as medical therapy for acromegaly.
    • Somatostatin analogs bind to somatostatin receptors and inhibit GH production.
    • Pegvisomant (Somavert®) is a GH receptor antagonist used to treat acromegaly.
    • Dopamine agonists (Cabergoline, Bromocriptine) can decrease GH production in a small percentage of acromegaly patients.
    • Vasopressin acts on V2 receptors in the collecting ducts of the kidney to initiate an intracellular cascade and increase water permeability.
    • Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R) are conditions that affect the body's ability to concentrate urine, leading to polyuria, nocturia, and polydipsia. Treatment options include replacing fluid losses and decreasing urine output. Desmopressin (DDAVP®) can increase water permeability in renal tubular cells to decrease urine volume.

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    Description

    Test your knowledge on treatment options for two different conditions - Acromegaly and Vasopressin Deficiency. Learn about medications, surgical interventions, and other therapies used to manage these conditions.

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