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Endocrine Pharmacology - Coggle Diagram

- - - - IGF-1 >3ULN
  - - - Surgery +/- radiotherapy
      - Surgery emergency if vision is compromised
    - - Somatostatin analogues (SSA)
        
        MOA
        
        Inhibits GH secretion
        
        Inhibits exocrine and endocrine pancreas
        
        Octreotide syntheticanalogue of somatostatin
        
        Administration
        
        Subcut
        
        Adverse Effects
        
        Choleithiasis
        
        Effect biliary system
        
        Glucose metabolism
        
        Injection reaction site
        
        N+V
        
        Flatulence
    - - Pegvisomant
        
        Indication
        
        Failled Somatostatin analogue therapy
        
        MOA
        
        Analogue of human growth hormone
        
        GH receptor antagonist
        
        Adverse Effects
        
        Hepatitis
      - Dopmaine Agonists
        
        MOA
        
        Dopamine agonists binds to D2 receptor and suppresses GH hypersecretion
        
        : Cabergoline-combination with SSA
    - - Normalise IGF1
      - Reduces complications and mortality
- - - - Cushingoid phenotype
      - Moonface
      - Central adiposity
      - Osteoporosis
    - - Depression
      - Mania
      - Psychosis
      - Insomnia
    - - Cataracts
      - Ulcers
      - Skin - Striase, bruising, thinning, ulcer
      - Hirutism, hypertension. hyperlipidaemia
      - Infections
      - Necrosis (femur head)
      - Obesity, osteoporosis
      - Immunosuppression
      - Diabetes
      - GI upset
  - - - Cortisol must be controlled pre-op
      - ACTH deficient post op and will need steroid replacement
    - - Pituitary directed drugs
        
        MOA
        
        Inhibition of ACTH secretion
        
        Drugs
        
        Pasireotide - somatostatin analog
        
        Cabergoline - dopamine agonist
      - Adrenal directed drugs
        
        MOA
        
        Suppression of steroidogenesis
        
        Drugs
        
        Ketoconazole - steroidogenesis inhibitors
        
        Mitotane - adrenolytic drug
      - Glucocorticoid receptor directed drugs
        
        MOA
        
        Glucocorticoid receptor antagonists
        
        Drugs
        
        Mifepristone
- - - - Stress
      - Overexercising
      - Nipple stimulation
      - Breast feeding
      - Pregnancy
    - - Prolactinoma
      - PCOS
      - Stalk effect
    - - Antipsychotic D2 antagonists
        
        Typical
        
        Phenothiazine
        
        Haloperidol
        
        Prochlorperazine
        
        Atypical
        
        Risperidone
        
        Olanzapine
        
        Antidepressants
        
        Clomipramine
        
        Amitriptyline
      - Anti-emetic D2 antagonists
        
        Metoclopramide
        
        Cimetidine
      - Antihypertensives
        
        Methyldopa
        
        Verapamil
      - Opirates
        
        Codeine
        
        Morphine
        
        Methadone
      - Other
        
        Oestrogens
        
        MOAIs
  - - - Normalised PRL levels
      - Return HPA axis fertility and reduce symptoms
    - - Drugs
        
        Cabergoline
        
        MOA
        
        Synthetic ergot derivative
        
        Dopamine receptor agonist with high affinity for D2 receptors
        
        Inhibits prolcatin secretion by acting on dopamine receptors in pituitary lactotrophs
        
        Pharmacokinetics
        
        Long acting
        
        Adverse Effects
        
        N+V
        
        Dizziness
        
        Gambling and sex addiction
        
        Contraindications
        
        Hx of pulmonary, pericardial and retroperitoneal fibrotic disorders
        
        Pregnancy?
        
        Bromocriptine
        
        2nd line 🥈
        
        Less effective
        
        Shorter DOA
        
        More side effects
        
        Safer in pregnancy
      - MOA
        
        Dopamine inhibits PRL secretion
      - "Cab & Bro Halt Hyper-Pro's Flow"
- - - - Mineralcorticoids
        
        Aldosterone
      - Glucocorticoid
        
        Cortisol
      - Androgens
        
        Dehydroepiandrosterone
    - - Stress hormones/ adrenergic
        
        Epinephrine
        Norepinephrine
  - - - Autoimmune - Addison's disease
      - Genetic
      - TB / infiltrative disorders
      - Haemorrhage
      - Infarction
      - Post meningitis - Waterhouse-Friderichsen syndrome
    - - Fatigue, collapse
      - Tanning (ACTH)
      - Postural hypotension
      - Hyperkalaemia (mineralocorticoid deficiency) and hyponatraemia
      - Abdominal pain
      - ↑ Mortality
    - - Glucocoricoid replacement
        
        Hydrocortisone
        
        MOA
        
        Activation of glucocorticoid receptor up-rgulates expression of anti-inflammatory proteins, and represses expression of pro-inflammatory proteins
        
        Transactivation and transrepression
      - Mineralocorticoid replacement
        
        Fludrocortisone
        
        Adverse Effects
        
        Hypertension
        
        Oedema
        
        Hypokalaemia
    - - Metabolic
        
        Osteoporosis
        
        Proximal myopathy
        
        Weight gain
        
        Diabetes
      - Immunological
        
        Immunosuppression
        
        Poor wound healing
        
        Infections
      - Skin / soft tissue
        
        Thinning
        
        Striae
        
        Hirsutism
        
        Cushingoid appearance
        
        Acne
      - Neuropsychiatric
        
        Psychosis
        
        Mania
        
        Depression
      - Mneumonic: CUSHINGOID
  - - - Cause
        
        Cortisol producing Adrenal adenoma
      - Presentation
        
        Osteoporosis
        
        Hypertension
    - - Causes
        
        Mineralocorticoid producing adrenal adeonma
        
        Conn's syndrome
        
        Bilateral adrenal hyperplasia
      - Presentation
        
        Hypokalaemia
        
        Fluid retention
        
        Resistant hypertension
        
        Family hx
      - Treatment
        
        Mineralocorticoid Receptor Antagonists
        
        Drugs
        
        Eplerenone
        
        Spironolactone
        
        Side Effects
        
        Gynecomastia
        
        Hyperkalaemia
        
        Loss of libido
        
        Feminization
        
        Mentrual irregularities
        
        GI disturbance
        
        Contraindicated in pregnancy
        
        Surgical removal for adenoma
    - - Causes
        
        Phaeochromocytoma
      - Treatment
        
        Phenoxybenzamine
        
        MOA
        
        α-receptor antagonist
        
        β-blockers
        
        NB Admin alpha blockers before beta blockets to prevent hypertensive crisis
        
        Surgical removal
      - Presentation
        
        5 P's of Phaeochromocytoma
        
        Pressure (High BP)
        
        Pain (headache)
        
        Perspiration
        
        Palpatations
        
        Pallor
- - - - ACTH
        
        Cushings Disease
      - GH
        
        Acromegaly / Giagantism
      - PRL
        
        Hyperprolactinaemia
      - TSH
        
        TSHoma - very rare
    - - Benign Pituitary Adenoma
        
        Micro / macroadenomas
        
        Secrete offending hormone
      - Stalk effect
        
        Mass compression on the pituitary stalk compromises inhibitory effect of Dopamine and PRL
        
        ↑PRL
  - - - GH deficiency
      - ACTH deficiency
      - TSH deficiency - Central hypothyroidism
      - FSH/ LH deficiency??
    - - Tumours
        
        Benign pituitary adenoma
        Functional or non-function
        Compression / destruction of pituitary galnd
      - Infiltrative disoders
      - Autoimmune conditions
      - Pituitary apoplexy
      - Traumatic Brain Injury
      - Immunotherapy causing hypophyisitis
      - Vascular - Sheehan's syndrome
      - Infections - TB, meningitis
      - Irradiation
- - - - MOA
        
        Selective agonist of V2 receptors in renal collecting duct
        
        Increases water re-absorption
        
        Reduces urine production
      - Adverse Effects
        
        Oedema
        
        Hyponatraemia
      - Never withold Desmopressin - dehydration
- - - - ACTH
        
        Hydrocortisone
        
        Adverse effects
        
        Metabolic syndrome in over replacement
        
        Dose
        
        10/5mg
      - TSH
        
        Levothyroxine
        T4 replacement
        
        T$ to high normal reference range
        
        Ignore TSH
      - ADH
        
        Desmopressin
        
        Monitor Na+
      - FSH/LH
        
        Male: Testosterone
        
        Achieve mid-range T-levels
        
        Normal erectile function and post pubertal hair growth
        
        Adverse effects
        
        Erythrocytosis
        
        Acne and oily skin
        
        Detection of subclinical prostate cancer
        
        Growth of metastatic prostate canecr
        
        Reduced sperm production and fetility
        
        Female: HRT: Oestrogen and progesterone
      - GH
        
        Growth hormone
        
        Little evidence of benefit
- - - - Graves disease
      - Toxic adenoma
      - Toxic Mutltinodular goitre
      - Toxic Phase Thyroiditis
    - - Inhibitors of TH synthesis: Thionomides
        
        🥇Carbimazole
        
        Adverse Effects
        
        Agranulocytosis
        
        Bone marrow suppression
        
        Crosses placenta
        
        Rash
        
        Arthralgia
        
        Propylthiouracil (PTU)
        
        Adverse Effects
        
        Fulminant Hepatic necrosis
        
        Safe in pregnancy
      - Beta blockers
        
        Propranolol
        
        MOA
        
        Blocks conversion of T4 to active form T3
      - Inhibitors of TH release
        
        Lugol's Iodine
    - - Radioactive iodine
      - Surgery
  - - - Autoimmune - Hashimoto's
      - Post thyroidectomy
      - Post thyroiditis
      - Iatrogenic
    - - T4 replacement
        
        Levothyroxine
      - T3 replacement
        
        Liothyronine
        
        Non useful
    - - Calcium
      - Iron
      - PPIs
      - Food - take on empty stomach, wait 30 min
      - Coeliac