Lanreotide
Mechanism | Medication | Indications |
---|---|---|
D2 agonists | Bromocriptine | Hyperprolactinemia |
Cabergoline | Hyperprolactinemia |
Step | Enzyme |
---|---|
Oxidation | Thyroperoxidase (TPO) |
Organification | Thyroperoxidase (TPO) |
Coupling | Thyroperoxidase (TPO) |
Deiodination | 5'-deiodinase |
Disorder | TRH | TSH | TH |
---|---|---|---|
Subclinical hypothyroidism | ↑ | ↑ | - |
1° Hypothyroidism | ↑ | ↑ | ↓ (1°) |
2° Hypothyroidism | ↑ | ↓ (1°) | ↓ |
Subclinical hyperthyroidism | ↓ | ↓ | - |
Struma ovarii | ↓ | ↓ | ↑ (1°) |
1° Hyperthyroidism | ↓ | ↓ | ↑ (1°) |
2° Hyperthyroidism | ↓ | ↑ (1°) | ↑ |
Cause | RAI | Thyroglobulin |
---|---|---|
Graves disease | ↑ | ↑ |
Multinodular goiter | ↑ | - |
Toxic adenoma | ↑ | - |
Thyroiditis | ↓ | ↑ |
Exogenous TH | ↓ | ↓ |
Disorder | PTH | Ca | P | Bone Disorder |
---|---|---|---|---|
1° Hypoparathyroidism | ↓ (1°) | ↓ | ↑ | - |
PTH-independent hypercalcemia | ↓ | ↑ (1°) | ↑/↓ (1°) | - |
1° Hyperparathyroidism | ↑ (1°) | ↑ | ↓ | Osteitis fibrosa cystica |
2° Hyperparathyroidism | ↑ | ↓ (1°) | ↑ (1°) | Renal osteodystrophy |
3° Hyperparathyroidism | ↑ | ↑ | ↑ | Renal osteodystrophy |
Vitamin D deficiency | ↑ | ↓ (1°) | ↓ (1°) | Rickets Osteomalacia |
Pseudohypoparathyroidism (PHP) | ↑ | ↓ (1°) | ↑ (1°) | Albright hereditary osteodystrophy |
Familial hypocalciuric hypercalcemia (FHH) | ↑ | ↑ | ↓ | - |
Deficiency | Mineralocorticoid | Glucocorticoid | Androgen | BP |
---|---|---|---|---|
21-Hydroxylase | ↓ | ↓ | ↑ | ↓ |
11-Hydroxylase | ↓ | ↓ | ↑ | ↑ |
17-Hydroxylase | ↑ | ↓ | ↓ | ↑ |
Disorder | Renin | Mineralocorticoid | Na & BP |
---|---|---|---|
Hypertension | ↓ | ↓ | ↑ (1°) |
Waterhouse-Friderichsen syndrome | ↑ | ↓ (1°) | ↓ |
CAH :: 21-Hydroxylase deficiency | ↑ | ↓ (1°) | ↓ |
CAH :: 11-Hydroxylase deficiency | ↓ | ↑ (1°) | ↑ |
CAH :: 17-Hydroxylase deficiency | ↓ | ↑ (1°) | ↑ |
Conn syndrome | ↓ | ↑ (1°) | ↑ |
Adrenal tumor | ↓ | ↑ (1°) | ↑ |
Exogenous steroid | ↓ | ↑ (1°) | ↑ |
Renin-secreting tumor | ↑ (1°) | ↑ | ↑ |
Hypotension | ↑ | ↑ | ↓ (1°) |
Disorder | CRH | ACTH | Glucocorticoid |
---|---|---|---|
Congenital adrenal hyperplasia (CAH) | ↑ | ↑ | ↓ (1°) |
Addison disease | ↑ | ↑ | ↓ (1°) |
Waterhouse-Friderichsen syndrome | ↑ | ↑ | ↓ (1°) |
Hypopituitarism | ↑ | ↓ (1°) | ↓ |
Exogenous steroid | ↓ | ↓ | ↑ (1°) |
Adrenal tumor | ↓ | ↓ | ↑ (1°) |
Ectopic ACTH | ↓ | ↑ (1°) | ↑ |
Cushing disease | ↓ | ↑ (1°) | ↑ |
Disorder | GnRH | LH & FSH | SH |
---|---|---|---|
Klinefelter syndrome | ↑ | ↑ | ↓ (1°) |
Turner syndrome | ↑ | ↑ | ↓ (1°) |
Menopause [Ovarian failure] | ↑ | ↑ | ↓ (1°) |
Resistant ovary [Savage] syndrome | ↑ | ↑ | ↓ (1°) |
Hypopituitarism | ↑ | ↓ (1°) | ↓ |
Kallmann syndrome | ↓ (1°) | ↓ | ↓ |
Hypothyroidism | ↓ (1°) | ↓ | ↓ |
Hyperprolactinemia | ↓ (1°) | ↓ | ↓ |
Pregnancy | ↓ | ↓ | ↑ (1°) |
Germ cell tumor | ↓ | ↓ | ↑ (1°) |
Exogenous steroid | ↓ | ↓ | ↑ (1°) |
Androgen insensitive syndrome (AIS) | ↑ | ↑ | ↑ |
Polycystic ovary syndrome (PCOS) | ↑/↓ | ↑/↓ | ↓/↑ |
Diagnosis | ADH | Osmolarity |
---|---|---|
Polydipsia | ↓ | ↓ (1°) |
Central DI | ↓ (1°) | ↑ |
Nephrogenic DI | ↑ | ↑ (1°) |
SIADH | ↑ (1°) | ↓ |
Disorder | Insulin | Glucose |
---|---|---|
Starvation | ↓ | ↓ (1°) |
DM type 1 | ↓ (1°) | ↑ |
DM type 2 | ↑ | ↑ (1°) |
Insulinoma | ↑ (1°) | ↓ |
Diagnosis | FBG | OGTT | HbA1c |
---|---|---|---|
Normal | < 100 mg/dL | 50-g 1-hour < 140 mg/dL | < 6.5% |
Gestational | < 125 mg/dL | 50-g 1-hour > 140 mg/dL 100-g 3-hour ≥ 2/4 | - |
Overt | > 125 mg/dL | 75-g 2-hour > 200 mg/dL | > 6.5% |
Mechanism | Effects | Medication | Indications |
---|---|---|---|
Insulin | ↑ Insulin | Rapid acting: Lispro Aspart Glulisine | DM |
Short acting: Regular insulin | DM | ||
Intermediate acting: NPH insulin | DM | ||
Long acting: Glargine Detemir | DM | ||
K channel blockers | ↑ Insulin | 1° Sulfonylureas: Tolbutamide Chlorpropamide | DM type 2 |
2° Sulfonylureas: Glimepiride Glipizide Glyburide | DM type 2 | ||
Meglitinides [-Glinides] | DM type 2 | ||
DPP-4 inhibitors | ↑ Insulin ↓ Glucagon | -Gliptins | DM type 2 |
GLP-1 analogs | ↑ Insulin ↓ Glucagon | Exenatide Liraglutide Semaglutide | DM type 2 |
Amylin analogs | ↓ Glucagon | Pramlintide | DM |
α-Glucosidase inhibitors | ↓ Glucose | Acarbose Miglitol | DM type 2 |
SGLT-2 inhibitors | ↓ Glucose | -Gliflozins | DM type 2 |
AMPK inducers | ↑ Insulin sensitivity | Biguanides: Metformin | DM type 2 |
PPAR-γ inducers | ↑ Insulin sensitivity | Thiazolidinediones [-Glitazones] | DM type 2 |
Receptor | Disease |
---|---|
GH | Laron syndrome |
PTH | Pseudohypoparathyroidism (PHP) |
LH & FSH | Resistant ovary [Savage] syndrome |
Androgen | Androgen insensitive syndrome (AIS) |
Insulin | Diabetes mellitus type 2 |
Vasopressin | Nephrogenic diabetes insipidus (DI) |
Test | Indication | Positive | Negative |
---|---|---|---|
GH stimulation test | ↓ Pituitary | Hypopituitarism | - |
GnRH stimulation test | ↓ Pituitary | Hypopituitarism | - |
Precocious puberty | Peripheral precocious puberty | Central precocious puberty | |
Progestin challenge test | 2° Amenorrhea | Non-anovulation | Anovulation |
TRH stimulation test | ↓ Pituitary | Hypopituitarism | - |
ACTH stimulation test | ↓ Cortisol | 1° Adrenal insufficiency | 2° Adrenal insufficiency |
Dexamethasone suppression test :: low-dose | ↑ Cortisol | Cushing syndrome | - |
Dexamethasone suppression test :: high-dose | ACTH-dependent Cushing syndrome | Ectopic ACTH | Cushing disease |
Saline suppression test | ↑ Aldosterone | 1° Hyperaldosteronism | - |
Oral glucose tolerance test | ↑ Glucose | Diabetes mellitus | - |
Water deprivation test | Polyuria | Diabetes insipidus | Polydipsia |
Desmopressin challenge test | Diabetes insipidus | Nephrogenic DI | Central DI |
Origin | Tumors |
---|---|
Surface ectoderm | Craniopharyngioma Pituitary adenoma |
Neuroectoderm :: neural tube | Pinealoma |
Neuroectoderm :: neural crest | Pheochromocytoma Paraganglioma |