Pituitary Macroadenomas Medication

  • Author: James R Mulinda, MD, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Oct 17, 2011
 

Medication Summary

Medications are used to control excess hormone secretion or to replace deficient hormones.

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Dopaminergic agents

Class Summary

These agents directly stimulate postsynaptic dopamine receptors. The dopaminergic neurons in the tuberoinfundibular process modulate the secretion of hormones from the anterior pituitary by secreting an inhibitory factor, believed to be dopamine.

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Bromocriptine (Parlodel)

 

Dopamine agonist used to normalize serum prolactin levels. Semisynthetic, ergot alkaloid derivative. Strong dopamine D2-receptor agonist. Partial dopamine D1-receptor agonist. FDA approved as an adjunct to levodopa/carbidopa but less effective than other dopamine agonists.

Might relieve akinesia, rigidity, and tremor associated with Parkinson disease. Stimulates dopamine receptors in the corpus striatum. Approximately 28% absorbed from the GI tract and metabolized in the liver. Approximate elimination half-life is 50 h, with 85% excreted in feces and 3-6% eliminated in the urine.

Initiate at low dosage and slowly increase dosage to individualize therapy. Assess dosage titration q2wk. Gradually reduce dose in 2.5-mg decrements if severe adverse reactions occur.

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Cabergoline (Dostinex)

 

Dopamine agonist used to normalize serum prolactin levels. Long-acting dopamine receptor agonist with high affinity for D2 receptors. Prolactin secretion by anterior pituitary is under hypothalamic inhibitory control exerted through dopamine.

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Pergolide (Permax)

 

Pergolide was withdrawn from the US market March 29, 2007. Potent dopamine receptor agonist at both D1 and D2 receptor sites. Approximately 10-1000 times more potent than bromocriptine on a mg-per-mg basis. Inhibits secretion of prolactin. Causes a transient rise in serum concentrations of growth hormone and decrease in serum concentrations of LH.

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Growth hormone receptor antagonists

Class Summary

Used for the treatment of acromegaly.

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Pegvisomant (Somavert)

 

Genetically engineered growth hormone receptor antagonist used to treat acromegaly. Useful in patients not responding to somatostatin analogues. May be used concurrently with somatostatin analogues after surgery and radiation.

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Somatostatin analogues

Class Summary

Used to control symptoms resulting from excess hormone secretion.

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Octreotide (Sandostatin)

 

Somatostatin analogue used to normalize growth hormone levels. Acts primarily on somatostatin receptor subtypes II and V. Inhibits growth hormone secretion and has multiple other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

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Contributor Information and Disclosures
Author

James R Mulinda, MD, FACP, FACE  Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc

James R Mulinda, MD, FACP, FACE is a member of the following medical societies: American College of Clinical Endocrinologists and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dimitris A Papanicolaou, MD  Assistant Professor, Department of Medicine/Endocrinology, Emory University

Dimitris A Papanicolaou, MD is a member of the following medical societies: American College of Physicians, Endocrine Society, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Yoram Shenker, MD  Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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