Normal pituitary Magnetic resonance scan正常垂体磁共振扫描.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Pharmacological Treatment of Prolactin excess: DA agonists Bromocriptine interacts with D2R on lactotrophs - Note only 7% reaches circulation do first-pass metabolism by the liver. Longer acting version (PARLODEL-LAR) – Pergolide (PERMAX) off label treatment Cabergoline (DOSTINEX) ergoline-derived dopamine agonist .More potent and longest half-life Mechansism of Action: Shrink pituitary PRL-secreting tumors, lower circulating PRL levels, and restore ovulation in approximately 70% of women with microadenomas and 30% of women with macroadenoma Side Effects: Nausea, headaches, orthostatic hypotension Drug-drug Interactions: May ?effects of anti-hypertensives, and ? effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics Growth hormone Promotes growth: skeleton, muscles, viscera Effects mediated by somatomedins (e.g. IGF1, 2...) Released at night during growth Variety of metabolic effects Anabolic, positive nitrogen balance Anti-insulin Stimulated by GHRH, stress, exercise Inhibited by somatostatin Glucose Uptake Increased Protein Synthesis Glucose Uptake Fat deposition Protein Synthesis Gluconeogenesis Increased Organ and Tissue growth Physiological Effects of GH Growth Hormone Deficiency Children: Dwarfism. Most common is isolated idiopathic Insulin-stimulated hypoglycemia induced GH 10 μg/L Exclude nutritional deficiencies Height ≥ 2–2.5 SD below normal, delayed bone age. Adults 90% have overt pituitary hypofunction due to disease, pituitary adenoma or iatrogenic Insulin-stimulated hypoglycemia induced GH 3 μg/L 9 year old Peruvian girl (80 cm) with GH receptor defect Primary Therapeutic Objective Clinical Condition Growth Growth failure in pediatric patients : Growth hormone deficiency Prader-Willi syndrome Turner syn