eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hypopituitarism: Treatment & Medication

Author: Lawrence A Wetterau, MD, Assistant Professor, Section of Endocrinology, Children's Hospital Central California
Contributor Information and Disclosures

Updated: May 5, 2009

Treatment

Medical Care

Appropriate treatment primarily involves appropriate hormone replacement.

Surgical Care

Tumor location and type dictate the choice of surgical procedures.

Consultations

Consultation with a pediatric hematologist-oncologist is necessary for patients with a pituitary tumor or histiocytosis X.

Diet

Diet is unrestricted.

Activity

Activity is unrestricted.

Medication

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.5

Endocrine hormones

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


Somatropin (Nutropin, Genotropin, Saizen, Humatrope)

Recombinant human growth hormone (rhGH) used to treat growth failure and metabolic abnormalities that accompany GHD. Somatropin is a purified polypeptide hormone of recombinant DNA origin. The amino acid sequence of somatropin is identical to pituitary derived human GH. Growth response of infants and children with severe GHD secondary to congenital hypopituitarism often is remarkable (see Media file 1, which depicts the results achieved with rhGH therapy for 8 mo).

Adult

Pediatric

0.025-0.050 mg/kg/d SC hs

Glucocorticoids may decrease growth-promoting effects

Documented hypersensitivity; closed epiphyses; actively growing intracranial tumor; critical illness related to respiratory failure

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Regularly monitor growth velocity and assess IGF-I and IGFBP-3 levels at least annually during rhGH therapy; caution in diabetes mellitus; reconstitute with sterile water for injection if administering to newborns


Levothyroxine (Synthroid, Levoxyl)

In active form, influences 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.

Adult

Pediatric

Replacement: 100 mcg/m2/d, individualize and titrate according to thyroid function test (TFT) results
Neonates: 25-37.5 mcg PO qd; titrate based on TFT results
6-12 months: 50-75 mcg/d PO
1-5 years: 75-100 mcg/d PO
6-12 years: 100-150 mcg/d PO
>12 years: 150 mcg/d PO

Cholestyramine may decrease levothyroxine absorption; estrogens may decrease response to thyroid hormone therapy in patients with nonfunctioning thyroid glands; effect of anticoagulants increases when administered with levothyroxine; activity of some beta-blockers may decrease when hypothyroid patient is converted to a euthyroid state; phenytoin may decrease levels; soy protein ingestion can inhibit absorption of levothyroxine

Documented hypersensitivity; uncorrected adrenal insufficiency

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Caution in angina pectoris or cardiovascular disease; periodically monitor thyroid status


Hydrocortisone (Cortef, Solu-Cortef)

Used for cortisol replacement therapy; has mineralocorticoid activity and glucocorticoid effects.

Adult

Pediatric

Replacement: 8-12 mg/m2/d PO divided bid (usually two thirds in morning and one third in evening to simulate diurnal variation)
Acute adrenal insufficiency: 50-100 mg/m2 IV bolus initially; followed by 50-100 mg/m2/d IV divided q6h

Corticosteroid clearance may decrease with estrogens; may increase digitalis toxicity secondary to hypokalemia

Documented hypersensitivity; viral, fungal, or tubercular skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hyperthyroidism, osteoporosis, peptic ulcer, cirrhosis, nonspecific ulcerative colitis, diabetes mellitus, and myasthenia gravis; during intercurrent illness, maintenance dose must be increased 2-fold to 3-fold and/or parenterally administrated


Vasopressin (Pitressin)

Used for ADH replacement therapy; dose widely varies and is titrated depending on serum and/or urine sodium osmolality, fluid balance, and urine output; may be administered IM, SC, or as continuous IV infusion.

Adult

Pediatric

2.5-10 U IM/SC bid/qid

Lithium, epinephrine, demeclocycline, heparin, and alcohol may decrease effects; chlorpropamide, urea, fludrocortisone, and carbamazepine may potentiate effects

Documented hypersensitivity; coronary artery disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in patients with predisposition to thrombus formation and conditions associated with fluid and electrolyte imbalance, cardiovascular disease, seizure disorders, nitrogen retention, asthma, or migraine; excessive doses may result in hyponatremia


Desmopressin (DDAVP)

Increases cellular permeability of collecting ducts, resulting in reabsorption of water by kidneys; used for ADH replacement.

Adult

Pediatric

0.05-0.4 mg PO qd or divided bid; 5-40 mcg/d intranasally qd or divided bid

Coadministration with demeclocycline and lithium decreases effects; fludrocortisone and chlorpropamide increase effects of desmopressin

Documented hypersensitivity; platelet-type von Willebrand disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in patients with predisposition to thrombus formation and conditions associated with fluid and electrolyte imbalance or cardiovascular disease

More on Hypopituitarism

Overview: Hypopituitarism
Differential Diagnoses & Workup: Hypopituitarism
Treatment & Medication: Hypopituitarism
Follow-up: Hypopituitarism
Multimedia: Hypopituitarism
References
Further Reading
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References

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Keywords

hypopituitarism, growth hormone deficiency, GHD, multiple pituitary hormone deficiency, MPHD, pituitary hypothalamus, hypoglycemia, short stature, jaundice, hyponatremia, sepsis, microgenitalia, growth failure, diabetes insipidus, gonadotropin deficiency, cold intolerance, constipation, micropenis, obesity, craniofacial abnormalities, Kallmann syndrome, KS, septo-optic dysplasia, anencephaly, holoprosencephaly, Pallister-Hall syndrome, histiocytosis, tuberculosis, tuberculosis, sarcoidosis, lymphocytic hypophysitis, hemochromatosis, craniopharyngioma, germinoma, glioma, astrocytoma, pituitary adenoma, treatment, diagnosis

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Contributor Information and Disclosures

Author

Lawrence A Wetterau, MD, Assistant Professor, Section of Endocrinology, Children's Hospital Central California
Lawrence A Wetterau, 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.

Medical Editor

Phyllis W Speiser, MD, Chief of Pediatric Endocrinology, Schneider Children's Hospital; Professor of Pediatrics, New York University School of Medicine
Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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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