Hyperpituitarism Medication

  • Author: Robert J Ferry Jr, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Aug 11, 2010
 

Dopamine agonists

Class Summary

Dopamine agonists remain the treatment of choice for many patients with PRL-secreting tumors. They also comprise effective adjuvant medical therapy for GH excess.

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Bromocriptine (Parlodel)

 

Most often used to treat GH and PRL excess.

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Cabergoline (Dostinex)

 

A potent dopamine agonist with a very prolonged duration of action. Inhibits PRL secretion to a greater extent than bromocriptine.

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Somatostatin analogs

Class Summary

Analogues of somatostatin are the most effective form of medical therapy for GH excess. They effectively inhibit GH secretion, thus lowering the circulating IGF-I concentration. They may shrink tumor size.

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Octreotide (Sandostatin, Sandostatin LAR-Depot)

 

Forty times more potent than the natural hormone somatostatin in inhibiting GH secretion. Available in an immediate-release dosage form (Sandostatin) or long-acting depot form (Sandostatin LAR).

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Growth hormone receptor antagonists

Class Summary

These agents block GH action and, thus, the production of IGF-I.

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Pegvisomant (Somavert)

 

An analogue (recombinant) of human GH that functions as a GH receptor antagonist.

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Diagnostics

Class Summary

These agents are used as diagnostic tests for hypothalamic-pituitary ACTH function. These agents are used adjunctively (off-label indication) in Cushing syndrome to control cortisol secretion.

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Metyrapone (Metopirone)

 

Inhibits mainly the final step in cortisol biosynthesis and at high doses may also inhibit ACTH secretion directly.

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Antifungals, imidazoles

Class Summary

These agents are used adjunctively (off-label indication) in Cushing syndrome to control cortisol secretion.

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Ketoconazole (Nizoral)

 

Broad-spectrum antimycotic drug. Inhibits adrenal steroid biosynthesis at several sites, including side chain cleavage and 11-beta-hydroxylation.

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Anticonvulsants

Class Summary

These agents are used adjunctively (off-label indication) in Cushing syndrome to control cortisol secretion.

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Aminoglutethimide (Cytadren)

 

An anticonvulsant that inhibits conversion of cholesterol to delta-5-pregnenolone, which then reduces the production of adrenal glucocorticoids, mineralocorticoids, aldosterone, estrogens, and androgens.

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Contributor Information and Disclosures
Author

Robert J Ferry Jr, MD  Chief, Division of Pediatric Endocrinology and Metabolism, Le Bonheur Children's Hospital; Professor, Department of Pediatrics, University of Tennessee Health Science Center at Memphis; St. Jude Children's Research Hospital, Memphis, TN; Brigade Surgeon, 36th Sustainment Brigade, U.S. Army; Adjunct Professor, Pediatric Surgery Department, King Saud University, Riyadh, Saudi Arabia

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching; Genotropin Speakers Bureau Honoraria Speaking and teaching; Eli Lilly & Co. Grant/research funds Independent contractor; MacroGenics, Inc. Grant/research funds Independent contractor; Ipsen, S.A. (formerly Tercica, Inc.) Grant/research funds Independent contractor; NovoNordisk SA Grant/research funds Independent contractor; Diamyd Independent contractor

Coauthor(s)

Melanie Shim, MD  Clinical Instructor, Department of Pediatrics, Division of Pediatric Endocrinology, University of California at Los Angeles School of Medicine

Melanie Shim, MD is a member of the following medical societies: American Diabetes Association and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas A Wilson, MD  Professor of Clinical Pediatrics, Director of Pediatric Endocrinology, Department of Pediatrics, The School of Medicine at Stony Brook University Medical Center

Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London)  Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

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Pituitary macroadenoma.
A 16-year-old boy with Cushing disease.
On the left is an unaffected patient aged 12 years. On the right is the same patient aged 13 years after developing Cushing disease.
 
 
 
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