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Tx of diabetes

1) biguanides

metformin

- activate MAPK

- decrease liver glucose production output

- decrease insulin resistance

2) Thiazolidinediones ( rosiglitazone, piaglitazone)

- decrease liver glucose production output

-increase insulin sensitivity

3) Sulphonylureas ( glimepride)

- stimulate b cells to increase insulin production

4) meglitidines ( nateglinides, repaglinide)

- same as (3) but short acting .

5) alpha-glucosidase inhbiitor ( acarbose)

- slow down CHO digesition and absorption.

Growth homrone releasing hormone -> somatotrophs-> growth hormone -> all cells

Corticotrophin releasing hormone-> corticotrophs-> ATCH-> adrenal cortex

Gnrh( gonadotrophin releasing hormone) -> gonadotrophs -> LH/FSH -> ovaries/testes

TRH-> thyrothrops-> TSH-> thyroid glands

Dopamine -> lactotrophs-> prolactin

Hypopitutarism

- failure of anterior pituitary function which may affect a single or more; all homronal secretion ( panhypopituitarism)

-leads to 2* gonodal,thyroid, adrenal failure

Causes:

Trauma

Lymphoytic hypophysis

Infraction( PPH; sheehan syndrome; pituitary necrosis)

Radiotherapy

Infiltration by sarcoidosis

Tumours

Hormone replacement therapy:

TSH: thyroxine (levothyroxine)

Prolactin: no replacement

ATCH: hydrocortisone

GnRH: testosterone/ ostrogen

GH : GH

Causes of hyper prolactin:

- Pituitary stalk effect; no dopamine to inhbiit prolactin

-Drugs that inhibit prolactin; anti-psychotics, anti-depresssant

- Prolactioma

- Pregnancy/lactation

Non-functioning pituitary tumors can cause:

-headache/dizziness/ N+V?

- eye movement problems

- visual disturbances

affect secretion of other hromones

IX:

- Imaging CT/MRI

-check prolactin

-visual assessment.

Tx:

- Surgery- if vaginal fluid compromised/ medical therapy unsucessful

- Dopamine agonist- bromocriptine & cabergoline

- Dopamine agonist contraindicated in pregnancy. [Prolactin] not useful. Monitor visual field only.

Acromegaly- excessive growth hormones

Clinical features:

- Large interdental space

- Large hand and feet

- Headache/ sweaty

- Cardiomyopathy

-Facial alteration.

- visual impairment

Ix:

- Glucose tolerance test

- Glucose supression test

- look for IGF-1, has long 1/2 life.

-MRI for pituitary

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