Page 700 - Basic _ Clinical Pharmacology ( PDFDrive )

686 SECTION VII Endocrine Drugs

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C ASE STUD Y ANSWER

While growth hormone (GH) may have some direct at risk for multiple hypothalamic/pituitary deficiencies.
growth-promoting effects, it is thought to mediate skeletal He may already have or may subsequently develop ACTH/
growth principally through production of insulin-like cortisol and TSH/thyroid hormone deficiencies and thus
growth factor-I (IGF-I) at the epiphyseal plate, which acts may require supplementation with hydrocortisone and
mainly in an autocrine/paracrine manner. IGF-I may also levothyroxine, in addition to supplementation with GH
promote statural growth through endocrine mechanisms. and testosterone. He should also be evaluated for the pres-
The findings of small testes and a microphallus in this ence of central diabetes insipidus and, if present, treated
patient suggest a diagnosis of hypogonadism, likely as a with desmopressin, a V vasopressin receptor–selective
2
consequence of gonadotropin deficiency. This patient is analog.