Pituitary disorders - Drug treatment options

Pituitary diseases are relatively common entities in the general population . They include pituitary adenomas and hypopituitarism. Pituitary tumours ca n cause symptoms of mass effect and hormonal hypersecretion that can he rev ersed with surgical resection or debulking of the adenoma, radiotherapy, or medical treatment. Transsphenoidal adenomectomy is the treatment of choice for acromegaly, Gushing's disease, gonadotropin-secreting tumours; and thy rotropin (TSH)-secreting adenomas. Pituitary irradiation and medical therap y are secondary options. Conversely, medical treatment is the primary choic e for prolactinomas, Dopamine agonists are very effective in the treatment of prolactin (PRL)-secreting tumours, with rates of control as high as 80 t o 90% for microprolactinomas (<10mm) and 60 to 75% for macroprolactinomas ( greater than or equal to 10mm). Somatostatin analogues have also shown effi cacy in patients with acromegaly who have not responded to surgery or in pa tients with TSH-secreting adenomas who have not improved with surgery and r adiotherapy. In patients with Cushing's disease, who are not cured surgical ly or who relapse after pituitary adenomectomy and irradiation, steroidogen ic inhibitors can he an efficient method of controlling the hypercortisolis m. Pituitary insufficiency is the partial or complete loss of the anterior hyp ophyseal function, which is due to hypothalamic or pituitary disease. Altho ugh the classic sequence Of loss of pituitary secretion is growth hormone ( GH), gonadotropins, TSH, and corticotropin (ACTH), the order to begin the r eplacement therapy of the deficient hormone(s) is cortisol, thyroxine, andr ogens/estrogens and, if necessary, GH. There are multiple preparations that can be used to achieve clinical and biochemical improvement. In general, t he hormone replacement therapy is lifelong.