Hormonal Agents
- PROLACTINOMA is a pituitary
Endocrine System
- A complex communication system
that is responsible for maintaining
balance
- Works hand-in-hand with nervous
system for regulatory functions
- NS involves neurotransmitters that
bind to specific receptors
- ES involves hormones which are
released into the bloodstream and
react with target cells found in target
organs (unspecified) to illicit
response
- Works by NEGATIVE feedback
Hormones
- Hormones are important for survival,
adaptation, and reproduction
- Hormones are triggers that
REGULATE bodily functions;
whereas NS controls functions
- Hormones affect heart rate, appetite,
sleep cycle or Circadian rhythm
- Adrenal Glands
CLASS OF HORMONES based on CHEM.
STRUCTURES
A. Amino acid-based
- Contain peptides and proteins
B. Steroids
- Derived from cholesterol
PARTS OF THE ENDOCRINE SYSTEM
Pituitary Gland
- Aka MASTER gland
- Causes the release of
STIMULATING hormones
- Responsible for the release of
oxytocin and ADH by the posterior;
and the rest by the anterior
Prolactin
tumor which leads to excessive PRL
 infertility and galactorrhea
Pineal Gland
- Specifically releases MELATONIN
for Circadian rhythm
- Melatonin is affected by photo
period; thus, melatonin levels are
highest at night or during dark photo
period
- Melatonin is an effective antioxidant
that protects the body from free
radicals like nitric oxide and
hydrogen peroxide
Parathyroid Glands
- Secretes parathyroid hormone and
calcitonin
- Located on top of the kidneys
- Responsible for the production of
aldosterone, corticosterone, and
cortisol
OTHER ORGANS
Pancreas
- Divided into two: exocrine and
endocrine
- EXOCRINE portion (85% of total
mass) involves ACINAR and DUCT
TISSUE for the secretion of
DIGESTIVE ENZYMES
- ENDOCRINE portion involves ISLET
OF LANGERHANS for the secretion
of INSULIN and GLUCAGON
HORMONE RELEASE MECHANISMS
Humoral
- Response to changing levels of ions
Neural - Insulin-like growth factor is aka
SOMATOMEDIN  mediates
- Most hormones are triggered by this
growth hormone effects
mechanism
- SOMATOSTATIN is aka growth
- Carried out by nerve stimulation
hormone INHIBITING hormone
Hormonal - Hormones that can INCREASE
glucose: 1) GH, 2) glucagon, 3)
- Stimulation received from other epinephrine, and 4) cortisol
hormones (e.g., thyrotropin-
releasing hormone) Somatropin
- Derived from human cadaver
pituitaries
Hypothalamus - Prions are proteinaceous particles
- Does not produce specific that can cause encephalitis,
hormones, but rather, RELEASING specifically, CREUTZFELDT-JAKOB
hormones disease  rare neurodegenerative
- Came from the Greek words hypo disorder affecting animals and
meaning under and thalamus humans; have long incubation
meaning chamber periods but progresses rapidly
- Found at the base of the brain, near (almost always fatal)
the pituitary gland - CJ dx is similar to Madcow disease;
prions are a form of protein particles
that have abnormal forms and lack
nucleic acids
PITUITARY GLAND
Somatrem
- Consists of anterior and posterior
- ANTERIOR = - RECOMBINANT GH for GH
ADENOHYPOPHYSIS deficiency in both children and
- POSTERIOR = adults
NEUROHYPOPHYSIS
- Posterior lobe does NOT produce
hormones; it only acts as STORAGE DEFICIENCY
for oxytocin and ADH Dwarfism
- TROPIC hormones are those that
are specifically produced by - GH affects GROWTH or
ANTERIOR lobe and regulates the EPIPHYSEAL plates which are
proper function of OTHER hormones specialized cartilage near long
- PRL = prolactin bones (i.e., femur) involved in bone
- MSH – melanocyte-stimulating lengthening and height
hormone - These plates usually stop after
puberty
- Dwarfism occurs when GH lacks
ANTERIOR PITUITARY HORMONES even before puberty
- To maximize growth potential getting
A. Growth Hormone balanced diet and avoiding nutrient
- Aka SOMATOTROPIN deficiency
 - Advertised drugs like Cherifer are
only effective during the growth gap
phase
After Puberty
- Posture, building muscles, and using
heels are the best way to look taller
USES
- E.g., Octreotide and Lanreotide
- Synthetic substances that are
chemically-related to somatostatin
(14 amino acid peptide)
- Synthetic analogs that can inhibit the
release of GH, glucagon, insulin,
and gastrin
- Octreotide is the MOST WIDELY
USED because it is 45x more potent
than somatostatin

1. Prader-Willi Syndrome  Dopamine Agonists

- Characterized by hypotonia (weak - E.g., Bromocriptine and
muscles) and short stature Cabergoline
2. Turner syndrome
- Results to female infertility and short  Pegvisomant
stature - Displaces the binding of GH to the
3. Idiopathic short stature specific receptors
- Aka NOONAN syndrome  genetic - Used specifically for
disorder characterized by ACROMEGALY
DYSMORPHIC facial features - Polyethylene derivative mutant of
TOXICITY GH

- Can cause PSEUDOTUMOR

CEREBRI  rare, serious adverse
effect in children
IGF-1 Analog
- Mecasermin and Mecasermin
rinfabate which are FDA-approved 2
forms of recombinant human IGF-1
- Mecasermin rinfabate is a complex
recombinant of the human IGF-1
EXCESS
- Acromegaly (meaning enlarged
extremities) usually occurs AFTER
puberty
- Gigantism usually occurs BEFORE
puberty
- Epiphyseal plates usually close at
around 13-15 in females, where as
15-18 for boys
TREATMENT FOR EXCESS
B. FSH and LH
- are collectively known as
GONADOTROPINS for reproduction
- Gonads produce gametes aka sex
cells
FSH
- In men, function in spermatogenesis
- SPERMATOGENESIS is the
process by which spermatozoa are
produced form male primordial germ
cells by mitosis and meiosis
hCG
- Nearly identical to LH
- Measured in pregnancy test kits,
where HIGH LEVELS indicate
pregnancy
FSH and LH in Menstrual Cycle

 Somatostatin analogs
 - Usually has 28 days but can last up
to 40 days (21-40 days is normal
range)
Menstrual Phase (Days 1-5)
nd
- 2 day is the heaviest flow of blood
- Bleeding days where the thick
endometrium lining in the uterus is
casted off
Follicular Phase (Days 1-13)
- Usually begins in the 1st day of cycle
- Pituitary gland secretes FSH 
production of egg cell by ovary
- FSH also stimulates progesterone
 produce endometrium, the lining
of the blood vessels and soft tissue
Ovulation Phase (Day 14)
- The released matured egg cell is
swept into the fallopian tube
- Increased levels of estrogen
Luteal Phase (Day 15-28)
- Aka SECRETORY phase
- Corpus luteum releases more
progesterone
- Egg cell release during ovulation
phase stays in fallopian tube for 24
hours; where it will disintegrate
along with the formed endometrium
if no sperm cell impregnates it
- Most fertile phase are DAYS 19, 20,
and 21
GONADOTROPIN ANALOGS
*Follitropin alfa and beta only differs in
carbohydrate side chains
Human Chorionic Gonadotropin
- Supports corpus luteum during early
stages of pregnancy
- CRYPTORCHIDISM is the failure of
the testes to descend from its
intraabdominal location in the
scrotum; common in pediatric
patients
GnRH ANALOG
- Increase testosterone and
progesterone levels, where their
effects depending on manner of
administration
- STIMULATION causes the release
of FSH and LH levels; seen when
analogs are given INTERMITTENLY
or IRREGULARLY
- INHIBITION when given
CONTINUOUSLY; inhibitory effects
are effective in the management of
breast and prostate cancer by
preventing the conversion of FSH to
estrogen (in breast cancer) and LH
to testosterone (prostate)
TOXICITY
- GnRH analogs are C/I in pregnant
and breastfeeding women
- In women, can cause masculination
and hirsutism (excess hair growth)
- In men, can cause femination
C. SEX HORMONES
- Estrogen is also present in men for
sexual growth and development
1. Estrogen
- Too much estradiol can cause acne,
loss of sex drive, depression,
osteoporosis as well as increased
uterine and breast cancer risk
Synthetic Estrogens
- Common component of oral
contraceptives
- OCPs MOA decrease FSH levels 
no ovulation by maintaining more
consistent hormone levels where no
 peak estrogen levels, no egg cell is
released
- OCPs thicken cervical mucus to
prevent sperm from reaching the
egg
- OCPs are commonly combined with
Progesterone
- Norethisterone aka Norethindrone is
an analog of progestin
- CYPROTERONE is an
ANTIANDROGEN  suppresses
testosterone action in tissues and
blocks androgen receptors to
suppress LH
- OCPs should be taken for a period
of 4 weeks or 28 days in a row and
start a new pack on the 29 th day; the
last 7 pills in the pack are placebo
- If missed dose, take it as soon as
you remember; if 1 day passes, take
2 pills
- OCPs should not be used with
antibiotics as they decrease the
effects of OCPs
- OCPs should be consulted with a
doctor; partnered with abstinence
and safe sex
ANTI-ESTROGEN
- All can be used for breast cancer
Clomiphene
- Used to induce ovulation in women
who do not produce egg cells but
wish to become pregnant
- Under the class of OVULATORY
STIMULANTS
Aromatase Inhibitors
- Aromatase is an enzyme that
converts androgen to estrogen\
2. Progesterone
- Main purpose is to prepare the
uterus for pregnancy
- Helps thicken the lining of the uterus
to prepare for a fertilized egg; and
helps maintain this lining during
pregnancy
- Important in child-bearing years as
well as in breast development and
feeding
Synthetic Progesterone
Progestin
- A term for laboratory-made
progesterone
- Most OCPs are combined with this
analog
- All progestin and progesterone
products are made in the laboratory
like Provera (oral) and Depo-Provera
(IM)
TYPES OF OCPs
 Morning After Pills
- Emergency birth control pill
- Emergency contraception is used to
prevent pregnancy when engaged in
unprotected sex or inadequate
contraception
- Back-up birth control
 Gossypol
- From Gossypium hirsutum or
cottonseed
- A spermicide used to immobilize or
kill the sperm before entry to uterus
- Single-use applicator that contains
this gel which is applied inside the
vagina to
 Monophasic – same amount
 Biphasic – provide 2-3 different pills
 Triphasic – ingredients are taken at
different times during the 21 day
cycle
 Implant is implanted in the adipose
tissue
 *RIFAMPIN (anti-TB) is known to
decrease the effects of OCPs
OTHER TYPES OF CONTRACEPTIVES
 Vaginal Ring
- inserted in vagina and releases
progestin and estrogen  prevent
egg release
 IUD
- T-shaped plastic device inserted in
uterus to thicken the cervical mucus
 block sperm and egg from
meeting
- IUD with Copper  Copper is a
spermicide
NATURAL METHODS
Calendar Days
- To determine fertile days Example:
Shortest cycle is 26 days  26-18 =
8 days  8th day is the start of
ovulation period and thus, unsafe
- To determine the last fertile day of
cycle, find the longest cycle
example: 30 days is longest cycle 
30 – 11 = 19 days, the day after is
the SAFE day
ANABOLIC STEROIDS
- Prohibited for the use of athletes
according to Olympic committee
along with GH
- Stimulate muscle strength and
growth
Trenbolone Acetate
- Steroid that is approved for use in
maintaining CATTLE WEIGHT and
to form more muscles
- Given prior to delivery to the
slaughter house to increase muscle
mass
ANTI-ANDROGEN
Alpha Reductase Inhibitor
- Alpha Reductase converts
testosterone to dihydrotestosterone
- High levels of androgens and
dihydrotestosterone can shrink hair
follicles  brittle, thinner hair\
Androgen Receptor Blockers
- Higher testosterone  higher risk for
prostate cancer
D. ADRENAL HORMONES
- Adrenal glands aka SUPRARENAL
glands due to their location \
- Triangular-shaped glands located on
top of kidneys which produce
hormone for the regulation of
metabolism, immune system, and
blood pressure (aldosterone)
E. PROLACTIN
- Amenorrhea is the absence of
menstrual cycle
- Dopamine is a physiologic inhibitor
of prolactin
POSTERIOR PITUITARY HORMONES
A. OXYTOCIN
- Effective stimulant of uterine
contraction
- Given IV to induce or reinforce labor
B. VASOPRESSIN
- Central DI can cause polyuria due to
decreased ADH
- Nephrogenic DI can cause urine to
become DILUTED; inability to form
concentrated urine due to impaired
renal tubule response
TOXICTY
SIADH
- Syndrome of Inappropriate
Antidiuretic Hormone Secretion 
treatment of choice is
Demeclocycline