GROWTH

HORMONES
1. GROWTH HORMONE

o 2 hypothalamic hormones regulate growth hormone:

GH-releasing hormone (GH-RH; somatropin)
GH-inhibiting hormone (GH-IH; somatostatin)
o GH does not have a specific target gland.
o It affects body tissues and bone

o GH replacement stimulates linear growth when there are

GH deficiencies.
 GH DRUGS CANNOT BE GIVEN
ORALLY BECAUSE THEY ARE
INACTIVATED BY GI ENZYMES.
Subcutaneous (subcut) or
intramuscular (IM)
administration is necessary.
 1. SOMATROPIN
DRUG THERAPY: GROWTH HORMONE DEFICIENCY)

Is a GH used to treat growth failure in children because of GH

deficiency.
Somatropin is a product that has the identical amino acid
sequence as human growth hormone (HGH);
It is contraindicated in pediatric patients who have growth
deficiency due to Prader-Willi syndrome and in those who are
severely obese or who have severe respiratory impairment
because fatalities associated with these factors can occur.
SOMATROPIN
DRUG INTERACTIONS:

Corticosteroids can inhibit the effects of somatropin.

Can enhance the effects of antidiabetics nd can cause

hypoglycaemia.
SOMATROPIN
SIDE EFFECTS:

Paresthesia(burning or prickling sensation), arthralgia (joint

pain), myalgia (muscle pain), peripheral

edema, weakness, and cephalgia (cluster headache)

SOMATROPIN
ADVERSE REACTION:

 Seizures; intracranial hypertension, and secondary

malignancy (e.g. leukemia)
Gigantism – excessive growth during childhood.
Caused by a Pituitary tumor.

Acromegaly – excessive growth after puberty

Caused by a
Pituitary
tumor.
If the tumor cannot be destroyed by radiation GH receptor
antagonist, somatostatin analogues or dopamine agonist are
given acting by either blocking GH receptor sites or inhibiting
secretion of GH.
If the tumor cannot be destroyed by radiation GH receptor
antagonist, somatostatin analogues or dopamine agonist are
given acting by either blocking GH receptor sites or inhibiting
secretion of GH.
2. SOMATOSTATIN
DRUG THERAPY: GROWTH HORMONE EXCESS

GH RECEPTOR ANTAGONIST

Pegvisomant
 Blocks GH receptor sites, preventing abnormal growth by
normalizing Insulin-like growth factor 1 (IGH-1) level.
 Given injection
SOMATOSTATIN
SIDE EFFECTS:

hyperhidrosis (abnormally excessive sweating ); cephalgia

and fatigue.

ADVERSE REACTION:

Chest pain, hypertension, and elevated hepatic

transaminases.
SOMATOSTATIN
SOMATOSTATIN ANALOGUES

Lanreotide
 Has a duration of 28 days after a single injection,
therefore injections are given every 4 weeks.
 Administered deep subcutaneous.

SIDE EFFECTS

Diarrhea, abdominal pain, nausea, vomiting, constipation,

weigth loss and flatulence.
SOMATOSTATIN
DOPAMINE AGONIST

Bromocriptine
 Inhibits the secretion of GH caused by pituitary
adenomas.
 Available in oral forms and has fewer side effects.
SOMATOSTATIN
ADVERSE REACTION

Cardiac toxicity ( hypertension, myocardial infarction, and

angina)
Cerebrovascular toxicity (stroke and seizure)
 Should be discontinued if hypertension occurs due to
pregnancy (preeclampsia, eclampsia or PIH)
SOMATOSTATIN
ADVERSE REACTION

Cardiac toxicity ( hypertension, myocardial infarction, and

angina)
Cerebrovascular toxicity (stroke and seizure)
 Should be discontinued if hypertension occurs due to
pregnancy (preeclampsia, eclampsia or PIH)
 THYROID-
STIMULATING
HORMONE
Stimulates the Thyroid gland to release thyroxine (T3)
and triiodothyronine (T4).
1.  THYROTROPIN
A purified extract of TSH for thyroid cancer.
Used as a diagnostic agent to differentiate between primary
and secondary hypothyroidism.

SIDE EFFECTS
Symptoms of hyperthyroidism (nervousness,
anxiety and irritability., sensitivity to heat.
An irregular and/or unusually fast heart rate
(palpitations)
Urticaria (Hives), rash, pruritus, and flushing
ADENOCORTICOTROPIC
HORMONE (ACTH)
1. COSYNTROPIN
A synthetic ACTH, is only approved for diagnostic purposes
and is less potent and less allergenic than corticotrophin.
Stimulates the production and release of cortisol,
corticosterone, and androgens from the adrenal cortex.
Administered via IM or IV

Caution is advised when administering in patients receiving

diuretics; can increase electrolyte loss.
2. CORTICOTROPIN
Used to diagnose adrenal gland disorders;
Used to treat multiple sclerosis and treat infantile spasms.
Available as Repository Corticotropin Injection (RCI),
administered via IM or subcut.
RCI controls the synthesis of ACTH from cholesterol, which
stimulates adrenal glands in releasing it’s hormones.
PROLACTIN
PROLACTIN
Primary function of prolactin (PRL) is stimulation of breast tissue for milk
production.
 Hypoprolactinemia – deficiency PRL
 Hyperprolactinemia-excess PRL

o Males – excess breast tissue (gynecomastia) and may lactate (galactorrhea),

decrease sperm production.
o Females – can experience lactation not pregnancy related, amenorrhea.

Excess PRL can be treated with dopamine agonist

Bromocriptine
Cabergoline – better tolerated, has a longer half-life.
 POSTERIOR LOBE
(NEUROHYPOPHYSIS)
AGENTS
 POSTERIOR LOBE (NEUROHYPOPHYSIS) AGENTS

The PPG secretes ADH (antidiuretic hormone) and Oxytocin.

ADH promotes water reabsorption from the renal tubules to maintain

water balance in the body fluids. When there is a deficiency of ADH,
large amounts of water is excreted by the kidneys (diabetes
insipidus); can lead to severe fluid volume deficit and electrolye
imbalances.

ADH preparations, vasopressin and desmopressin acetate can be

administered intranasal or by injections.
 POSTERIOR LOBE (NEUROHYPOPHYSIS) AGENTS

ADH is contraindicated in patients with moderate to severe renal

disease and in patients with hyponatremia or a history of such.

SIDE EFFECTS:

Hyponatemia, cephalgia
(A distinctive syndrome of headaches,
also known as cluster headache
or migrainous neuralgia).
Dyspepsia, diarrhea, nausea and vomiting.
 SIADH (SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE)
When secretion of ADH from the PPG (posterior pituitary gland) is excessive,
the most common cause is small cell carcinoma of the lung. Medications, other
malignancies, and stressors (pain, infection, anxiety, trauma) may also be
causative factors.

These conditions lead to an excessive amount of water retention expanding

the intracellular and intravascular volume.

This increased fluid volume causes enhanced glomerular filtration and

decreased tubular sodium reabsorption.

SIADH can be treated by fluid restrictions, by hypertonic saline or by drugs

such as: demeclocycline, conivaptan, tolvaptan
 SIADH (SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE)

Demeclocycline

Is a tetracycline antibiotic.
Adverse effect: photosensitivity, dental discoloration,
enamel hypoplasia.
Fluid and electrolytes must be monitored closely.
 SIADH (SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE)
Vaptans (conivaptan and tolvaptan)

Vasopressin receptor antagonists and are indicated for the treatment of

euvolemic hyponatremia in SIADH.
Tolvaptan is given orally. It has black-box warnings for patients with
alcoholism, hepatic disease and malnutrition; should be avoided in these
patients.
Vaptans are contraindicated in patients with hypovolemia.
Fluid restrictions should be avoided during therapy to prevent too rapid
an increase in serum sodium.
THYROID DRUGS
FOR HYPOTHYROIDISM:

1. Levothyroxine sodium

Drug of choice for the treatment of

primary hypothyroidism.

It increases the levels of T4 and

metabolically is deiodinated to T3.

Used to treat simple goiter and chronic

lymphocytic thyroiditis (Hashimoto’s
disease).
FOR HYPOTHYROIDISM:
2. Liothyronine sodium

Is a synthetic T3 with a biologic half-life

of 2.5 days with rapid onset of action.
Is indicated for use as replacement or
supplemental treatment for
hypothyroidism of any etiology.
Does not need to be deionated which
increases the availability for use by the
body tissues.
Initial therapy for treating myxedema
(hypothyroidism)
FOR HYPOTHYROIDISM:
3. Desiccated thyroid

Is a naturally occurring thyroid hormone

from porcine thyroid glands.

It contains both levothyroxine sodium

and liothyronine sodium

Used to treat hypothyroidism due to

thyroid atrophy, thyroid hormone
deficiency and goiter.
ANTITHYROID DRUGS
Reduce the excessive secretion of thyroid hormones by
inhibiting thyroid secretions.
Drug of choice are Thiourea derivatives (thiomides) :
decreases thyroid hormone production.
FOR HYPERTHYROIDISM:
1. Propylthiouracil (PTU) and methimazole

Used to control overactive thyroid due

to Graves disease, toxic nodular goiter.

Methimazole is 10 times potent than PTU

and has a longer half-life and the
euthyroid state is achieved in 2 to 4
months.
1. Propylthiouracil (PTU) and methimazole

DRUG INTERACTIONS:
 Oral anticoagulants (warfarin) – can cause increase in anticoagulation
effect.
Thyroid drugs decreased the effects of insulin and oral antidiabetics.
1. Propylthiouracil (PTU) and methimazole

NURSING RESPONSIBILITIES:

Teach patient to take drug with meals to decrease gastrointestinal symptoms.

Advise patient about effects of iodine and its presence in iodized salt, shellfish,
and OTC cough medicines.

 Emphasize importance of drug compliance; abruptly stopping antithyroid drug

could bring on thyroid crisis.
1. Propylthiouracil (PTU) and methimazole

NURSING RESPONSIBILITIES:

Teach patient signs and symptoms of hypothyroidism: lethargy, puffy eyelids and
face, thick tongue, slow speech with hoarseness, lack of perspiration, and slow
pulse. Hypothyroidism can result from treatment of hyperthyroidism.

Advise patient to avoid antithyroid drugs if pregnant or breastfeeding.

Antithyroid drugs taken during pregnancy can cause hypothyroidism in fetus or

infant.