Growth hormone: Growth hormone is naturally present in the human body, and it promotes the growth and development of all tissues, especially cartilage and bone. It is produced in the anterior lobe of the pituitary gland. Synthetic growth hormone is available as an injection called Somatropin, which is sold under brand names like Serostim, Saizen, Zorbtive, Genotropin, Humatrope, and Norditropin. Somatropin is most commonly used as a subcutaneous injection, and in some cases, it is injected intramuscularly. It is used in growth hormone deficiency, HIV to prevent muscle wasting, and in some disease conditions like chronic kidney disease and Turner syndrome to increase height. Adverse effects include injection site reactions like redness, swelling and thickening, insulin resistance, imbalance in blood sugar level, carpal tunnel syndrome, joint pain, edema, and increased cancer risk. Illicit use of growth hormone has been observed in athletes and bodybuilders.
Octreotide: Octreotide is a synthetic analog of the hormone somatostatin that regulates secretions of the pancreas and gastrointestinal system and other hormones like growth hormone. It is used to treat acromegaly, a condition caused by excess growth hormone. It is also used to control gastrointestinal bleeding and in the treatment of carcinoid tumors. Adverse effects include abdominal pain, fainting, headache, gallstones, hypothyroidism, diarrhea, constipation, and arrhythmias. Vitamin B12 deficiency may occur. There may be transient elevation of liver enzymes. Octreotide is available as a subcutaneous, intravenous, and intramuscular injection. It is sold at Bynfezia, Mycapssa, SandoSTATIN and SandoSTATIN LAR Depot. Octreotide has many drug interactions with insulin, affecting blood glucose levels, antidiabetics, quinidine, cyclosporine, bromocriptine, antihypertensives, and antiarrhythmics.
Oxytocin: Sold under brand names Pitocin and Syntocinon, oxytocin is used by the intravenous or intramuscular routes to stimulate uterine contractions during labor, induction of labor and to control uterine bleeding. It is naturally produced in the body by the hypothalamus and pituitary gland. Adverse effects include nausea, vomiting, headache, irregular heart rate, vaginal bleeding, uterine hyperstimulation, jaundice and seizures.
Antidiuretic hormone or ADH: Also known as vasopressin, it is a hormone produced by the hypothalamus and pituitary gland. It is involved in the regulation of body water and salt. Synthetic ADH in the form of desmopressin is used in the treatment of diabetes insipidus, a condition caused by deficiency of ADH, characterized by water loss by the kidneys. Synthetic versions are desmopressin (DDAVP) and vasopressin (Pitressin, Vasostrict). While desmopressin is more active on the V2 receptor in the kidneys, vasopressin is more effective on the V1 receptor on blood vessels. Hence, vasopressin is used to increase blood pressure in circulatory shock. Desmopressin is also indicated in bedwetting or nocturnal enuresis. Allergic reactions including anaphylaxis, intense vasoconstriction leading to cold and numb hands and feet, hyponatremia or low serum sodium, stomach pain, bleeding, and irregular heartbeats.
Corticosteroids: Corticosteroids are steroid hormones mainly produced in the adrenal glands. They may be glucocorticosteroids like cortisol or mineralocorticosteroids like aldosterone. Many synthetic versions are available and commonly used in various forms like tablets, injections, and creams.
Glucocorticosteroids are important in metabolism, response to stress, and immune responses. They have potent antiinflammatory properties. They are used in many conditions like skin disorders, autoimmune disorders, circulatory shock, adrenal insufficiency, and inflammatory disorders like Crohn’s disease and allergies. Commonly available drugs include prednisone (Rayos), prednisolone (Millipred, PediaPred), methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol), triamcinolone (Clinacort, Kenalog-10 and 40), dexamethasone (ZoDex), budesonide (Entocort EC, Uceris), fluticasone (Flovent), hydrocortisone (Cortef, Cortifoam) and betamethasone (Celestone Soluspan). Fluticasone, budesonide, mometasone, and beclomethasone are commonly used as inhaled corticosteroids. Adverse effects include agitation, blurred vision, cataract, delayed wound healing, high blood pressure, fluid retention, headache, gastric ulcers, weight gain, and Cushing’s syndrome. Cough and throat irritation is seen with the use of inhaled corticosteroids. There may be elevation of blood glucose levels in diabetics following glucocorticosteroid use. Long term use of glucocorticosteroids can suppress the adrenal gland and cause adrenal insufficiency. Long term use may also decrease bone mineral density and cause osteoporosis. Corticosteroids are tapered off slowly after chronic use to provide adequate time for adrenal cortisol production.
Mineralocorticosteroids are vital to maintain normal blood pressure and sodium and potassium metabolism. Deficiency is seen in Addison’s disease and adrenal failure. Commonly available mineralocorticoid is fludrocortisone, sold as Florinef. Adverse effects include increased blood pressure, muscle weakness, restlessness, insomnia and upset stomach.