Pediatric Hypopituitarism Medication

  • Author: Joel W Steelman, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Jul 14, 2011
 

Medication Summary

Agents used to treat hypopituitarism simply replace the deficient hormone or hormones. When appropriately administered, dosing is determined in a physiologic manner, and adverse effects are rare. Careful titration is critical. Consistent and accurate compliance with appropriately prescribed regimens is mandatory to avoid hormone deficiency or excess.

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Endocrine hormones

Class Summary

These hormones are designed to replace absent hormones in patients with a pituitary deficiency.

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Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Tev-Tropin)

 

Somatropin is an rhGH used to treat growth failure and metabolic abnormalities that accompany GHD. It is a purified polypeptide hormone of recombinant deoxyribonucleic acid (DNA) origin. The amino acid sequence of somatropin is identical to that of pituitary-derived human GH. The growth response of infants and children with severe GHD secondary to congenital hypopituitarism often is remarkable.

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Levothyroxine (Synthroid, Levoxyl, Tirosint, Unithroid)

 

In active form, levothyroxine influences the growth and maturation of tissues. Sufficient thyroid hormone is mandatory for normal growth, metabolism, and neurologic development. For central hypothyroidism, the goal is normal FT4.

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Hydrocortisone (Cortef, Solu-Cortef, A-Hydrocort)

 

Hydrocortisone is used for cortisol replacement therapy; it has mineralocorticoid activity and glucocorticoid effects.

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Vasopressin (Pitressin)

 

Vasopressin is used for ADH replacement therapy mainly in the intensive care unit (ICU) or inpatient setting. It may be given as a continuous intravenous (IV) drip or as intermittent injections. The dose widely varies and is titrated depending on serum and/or urine sodium osmolality, fluid balance, and urine output.

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Desmopressin (DDAVP, Stimate)

 

This agent increases the cellular permeability of collecting ducts, resulting in the reabsorption of water by the kidneys; it is used for ADH replacement.

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Androgen

Class Summary

These hormones are designed to replace testosterone absent secondary to gonadotropin deficiency.

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Testosterone (Delatestryl, AndroGel, Testim)

 

Testosterone is an anabolic steroid that promotes and maintains secondary sex characteristics in androgen-deficient males. Dosing routes include intramuscular and transdermal. Oral forms of testosterone are very rarely used in the United States.

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Estrogen Derivative

Class Summary

These hormones are designed to replace estrogen absent secondary to gonadotropin deficiency.

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Estradiol (Alora, Climara, Estrace, Estraderm)

 

Estradiol restores estrogen levels in girls with hypogonadotropism to concentrations that induce negative feedback at gonadotrophic regulatory centers, which in turn reduces the release of gonadotropins from the pituitary. Multiple studies have shown that estradiol will prevent bone loss at the spine and hip when started within 10 years of menopause.

Estradiol is used for hormone replacement and the induction of puberty. It acts by regulating the transcription of a limited number of genes. Estrogens diffuse through cell membranes, distribute themselves throughout the cell, and bind to and activate the nuclear estrogen receptor, a DNA-binding protein found in estrogen-responsive tissues. The activated estrogen receptor binds to specific DNA sequences or hormone-response elements, which enhances transcription of adjacent genes and, in turn, leads to the observed effects.

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Contributor Information and Disclosures
Author

Joel W Steelman, MD  Endocrine Consultant, Division of Endocrinology and Diabetes, Cook Children's Medical Center

Joel W Steelman, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Society for Bone and Mineral Research, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Pfizer Honoraria Speaking and teaching

Specialty Editor Board

Phyllis W Speiser, MD  Chief, Division of Pediatric Endocrinology, Steven and Alexandra Cohen Children's Medical Center of New York; Professor of Pediatrics, Hofstra-North Shore LIJ School of Medicine at Hofstra University

Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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; UNESCO Chair on Adolescent Health Care, University of Athens, 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, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, 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: Nothing to disclose.

Acknowledgments

I want to thank Simon Rhodes, PhD and Stephen Shalet, MD for kindly allowing me to republish illustrations from their work.

References

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The left photograph shows an untreated 21-month-old girl with congenital hypopituitarism. The right panel depicts the same child aged 29 months, following 8 months of growth hormone therapy.
Regulation of the development of the mammalian anterior pituitary gland by transcription factors. Following, inductive signals between the developing diencephalon and the oral ectoderm, early transcription factors guide the formation of rudimentary Rathke's Pouch (rRP) and then subsequent gene regulatory pathways control the determination, proliferation, and differentiation events that establish the specialized hormone-secreting cells. AP = anterior pituitary, IP = intermediate pituitary, PP = posterior pituitary. Modified by S. Rhodes from Mullen, R.D., Colvin, S.C., Hunter, C.H., Savage, J.J., Walvoord, E.C., Bhangoo, A.P.S., Ten, T., Weigel, J., Pfäffle, R.W., and Rhodes, S.J. (2007). Roles of the LHX3 and LHX4 LIM-homeodomain factors in pituitary development. Mol. Cell. Endocrinol., 265-266: 190-195.
Summary of Neuroendocrine Dysfunction following radiotherapy (courtesy of Stephen M Shalet, MD)
 
 
 
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