Hypopituitarism medical therapy

Hypopituitarism Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Hypopituitarism and panhypopituitarism are treated by replacement of appropriate hormones. Since most of the anterior pituitary hormones are proteins or glycoproteins released in pulsatile patterns, whose functions are to induce secretion of smaller molecule hormones (thyroid hormones and steroids), it is simpler and less expensive for most purposes to simply replace the target gland hormones. There are a few exceptions, such as fertility induction.

• GH is replaced with growth hormone.
• TSH is replaced with thyroxine.
• ACTH is usually replaced with hydrocortisone but any glucocorticoid may be used.
• LH and FSH are most often replaced by supplying the appropriate sex steroids (e.g., testosterone or estrogen and progestin). Virtually all people who need T or E2 replacement for hypopituitarism rarely have spontaneous, effective spermatogenesis or follicular maturation. Both GnRH by subcutaneous pump and gonadotropins (Pergonal) by daily subcutaneous injections have been used effectively to induce fertility.
• Prolactin is not usually replaced, as infant formula is readily available, simpler, and much cheaper.
• ADH is replaced most commonly with oral, nasal, and sometimes intravenous or subcutaneous desmopressin.
• Oxytocin is most important during labor and delivery at the end of pregnancy, and can be replaced in that circumstance by pitressin.