ADVANCES IN MEDICAL THERAPY FOR PITUITARY DISEASE - TREATING PATIENTSWITH GROWTH-HORMONE EXCESS AND DEFICIENCY

Two recent developments in the medical treatment of patients with pitu itary disease are discussed. Conventional treatment for patients with acromegaly has been surgery and/or radiotherapy. Dopamine agonist ther apy may be useful. Somatostatin is a naturally occurring neuropeptide that inhibits growth hormone (GH) secretion. The development of long-a cting preparations has resulted in a considerable advance in the medic al treatment of acromegaly, though some caution remains about the long -term side-effects of such therapy (e.g. cholelithiasis) and its cost/ benefit analysis. Although further epidemiological studies are require d, hypopituitarism appears to be associated with an increased mortalit y rate, and this has largely been attributed to GH deficiency. With th e widespread availability of recombinant GH (thereby circumventing any risks from cadaveric GH) many adult GH-deficient patients are now bei ng treated. Beneficial effects on body composition, nitrogen and calci um balance and bone mass have already emerged, although studies on 'we ll being' have been conflicting. The debate continues concerning the m inimum effective dose and who exactly should be treated, in view of th e costs incurred. The endocrinologists' use of long-acting somatostati n analogues and recombinant GH will undoubtedly increase over the next few years. Whilst it is clear that many patients with both acromegaly and hypopituitarism will benefit, long-term controlled trials are sti ll required to establish firmly the benefit in terms of major morbidit y.