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0.125 mg

aSee USP DI for complete dosage information.

aSee USP DI for complete dosage information.

sponses result in an approximate doubling of the basal hydrocortisone concentration in 30 to 60 minutes. If the response is not normal, adrenal insufficiency is indicated. Such adrenal insufficiency could be a result of either adrenal or pituitary malfunction, and further testing is required to distinguish between the two. Cosyntropin (250 ¡¿g infused within 4-8 hours) or corticotropin (80-120 U/day for 3-4 days) is administered. Patients with functional adrenal tissue should respond to this dosage. Patients who respond accordingly are suspected of hypopituitarism, and the diagnosis can be confirmed by other tests for pituitary function. Patients who have Addison disease, however, show little or no response.

Corticorelin. Corticorelin (Acthrel) is a synthetic peptide that may be used as an injectable in the determination of pituitary responsiveness. It possesses the amino acid sequence found in corticotropin-releasing hormone that is responsible for stimulating the release of ACTH.

MELANOTROPINS (MELANOCYTE-STIMULATING HORMONE)

Melanocyte-stimulating hormone (MSH) is elaborated by the intermediate lobe of the pituitary gland and regulates pigmentation of skin in fish, amphibians, and, to a lesser extent, humans. Altered secretion of MSH has been implicated in causing changes in skin pigmentation during the menstrual cycle and pregnancy. The two major types of melano-tropin, a-MSH and j-MSH, are derived from ACTH and S-lipotropin, respectively. a-MSH contains the same amino acid sequence as the first 13 amino acids of ACTH; j-MSH

has 18 amino acid residues. A third melanotropin, y-melano-tropin, is derived from a larger peptide precursor, proopi-omelanocortin (POMC). Some important endocrinological correlations include inhibitory actions of hydrocortisone on the secretion of MSH and the inhibitory effects of epinephrine and norepinephrine on MSH action.

LIPOTROPINS (ENKEPHALINS AND ENDORPHINS)

Opiates, such as opium and morphine, have been known for centuries as substances that relieve pain and suffering. Neuropharmacologists have theorized that opiates interact with receptors in the brain that are affected by endogenous substances that function as regulators of pain perception. The important breakthrough came in 1975, with the isolation of two peptides with opiatelike activity26 from pig brains. These related pentapeptides, called methionine-enkephalin (metenkephalin) and leucine-enkephalin (leuenkephalin), are abundant in certain nerve terminals and have been found in the pituitary gland.

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