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?

Mimic effects of endogenous GH Signup and view all the answers

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

3-6 months Signup and view all the answers

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

Insulin resistance Signup and view all the answers

Which hormone stimulates protein synthesis and growth?

Growth hormone (GH) Signup and view all the answers

Which hormone stimulates milk production and secretion?

Prolactin (PRL) Signup and view all the answers

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

Vasopressin Signup and view all the answers

Which hormone stimulates TSH & prolactin secretion?

Thyrotropin-releasing hormone (TRH) Signup and view all the answers

Which hormone stimulates LH/FSH secretion?

Gonadotropin-releasing hormone (GnRH) Signup and view all the answers

Which hormone inhibits growth hormone secretion?

Somatostatin Signup and view all the answers

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

Pasireotide Signup and view all the answers

Which drug blocks cortisol effects at the glucocorticoid receptor?

Mifepristone Signup and view all the answers

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

Pasireotide Signup and view all the answers

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

Spironolactone Signup and view all the answers

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

Eplerenone Signup and view all the answers

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

Phenoxybenzamine Signup and view all the answers

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

Hydrochlorothiazide (HCTZ) Signup and view all the answers

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

Syndrome of Inappropriate ADH (SIADH) Signup and view all the answers

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

All of the above Signup and view all the answers

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

Ketoconazole Signup and view all the answers

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

Suppresses ACTH secretion Signup and view all the answers

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

Metyrapone Signup and view all the answers

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

Insulin-Like Growth Factor (IGF-1) Signup and view all the answers

What is the primary treatment for acromegaly?

Transsphenoidal surgery Signup and view all the answers

Which condition can cause gigantism in children before puberty?

GH Excess in children before puberty Signup and view all the answers

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

Dopamine Signup and view all the answers

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

Vasopressin Signup and view all the answers

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

Desmopressin (DDAVP) Signup and view all the answers

Match the growth hormone effects with their corresponding characteristics:

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

Match the symptoms of deficiency with the corresponding group:

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

Match the goal of therapy with the corresponding treatment:

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

Match the monitoring items with the corresponding organization:

IGF-1, glucose, free T4 & lipids = American Academy of Clinical Endocrinologists Signup and view all the answers

Match the adverse effects with the corresponding group:

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

Match the characteristics with the corresponding GH release:

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 Signup and view all the answers

Match the following hormones with their actions:

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

Match the following pituitary disorders with their corresponding hormone deficiencies:

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

Match the anterior pituitary hormones with their actions:

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

Match the hypothalamic releasing hormones with their actions:

Thyrotropin-releasing hormone (TRH) = Stimulates TSH & 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 Signup and view all the answers

Match the posterior pituitary hormones with their actions:

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 Signup and view all the answers

Match the adrenal disorders with their corresponding hormone abnormalities:

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

Match the following medical conditions with their respective treatment options:

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®) Signup and view all the answers

Match the following drugs with their mechanism of action:

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 Signup and view all the answers

Match the following medical conditions with their diagnostic tests:

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 Signup and view all the answers

Match the following hormones with their effects:

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 Signup and view all the answers

Match the following medical conditions with their symptoms:

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 Signup and view all the answers

Match the following drugs with their administered routes:

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

Match the following drugs with their primary effects:

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

Match the following drugs with their adverse effects:

Eplerenone (Inspra™) = Hyperkalemia Pasireotide (Signifor®) = HA, fatigue, hyperglycemia & 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 Signup and view all the answers

Match the following drugs with their drug interactions:

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

Match the following hormones with their primary functions:

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 Signup and view all the answers

Match the following conditions with their primary treatments:

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 Signup and view all the answers

Match the following disorders with their treatment strategies:

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

Match the following treatments with the corresponding conditions:

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 Signup and view all the answers

Match the following drugs with their adverse effects:

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 & sedation Signup and view all the answers

Match the following drugs with their mechanisms of action:

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 Signup and view all the answers

Match the following conditions with their descriptions:

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 < 7.5-20mg pred EQ/day < 3 weeks Cushing’s Syndrome = Treatment with Osilodrostat if unable to have pituitary surgery, No disease resolution after surgery Signup and view all the answers

Match the following conditions with their treatments:

SIADH = Fluid restriction – < 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 Signup and view all the answers

Match the following conditions with their symptoms:

Hyponatremia = > 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 > 3 weeks dependent SIADH = Vasopressin excess, Rapid Na+ decreases can result in cerebral edema Signup and view all the answers

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

Stage 0 Signup and view all the answers

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

Estrogen Receptor Negative (ER-) Signup and view all the answers

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

Lung cancer 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+?

Neoadjuvant chemotherapy followed by adjuvant therapy Signup and view all the answers

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

IIB 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?

Different endocrine therapy + HER2 targeted therapy + taxane Signup and view all the answers

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

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

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

Trastuzumab + chemotherapy 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?

Ado Trastuzumab Emtansine 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?

Lapatinib 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?

Neratinib Signup and view all the answers

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

Lung cancer Signup and view all the answers

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

1 in 8 Signup and view all the answers

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

Luminal A 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?

Ado Trastuzumab Emtansine Signup and view all the answers

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

Inhibits both EGFR and ErbB2 (HER2) receptors Signup and view all the answers

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

Ado Trastuzumab Emtansine 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?

Adjuvant chemotherapy 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?

Olaparib 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?

Stage IIB 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+?

Neoadjuvant chemotherapy followed by adjuvant therapy Signup and view all the answers

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

All of the above 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.