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Panhypopituitarism Medication

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Nov 19, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Hormones

Class Summary

These medications are used for replacement of deficient hormones.

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

 

This drug provides cortisol replacement in patients with ACTH deficiency. Possesses both mineralocorticoid activity and glucocorticoid effects.

Levothyroxine (Levothroid, Levoxyl, Synthroid)

 

This drug is a hormone replacement used in patients with TSH deficiency. Rapidly inhibits the release of thyroid hormones via a direct effect on the thyroid gland and inhibits the synthesis of thyroid hormones. Iodide also appears to attenuate the cAMP-mediated effects of thyrotropin. In active form, influences growth and maturation of tissues. Involved in normal growth, metabolism, and development. The dose of L-thyroxine replacement is age dependent.

Somatropin (Genotropin, Humatrope, Nordotropin, Nutropin, Saizen, TevTropin, Omnitrope)

 

Primary use of GH is as a hormone replacement in short poorly growing children. Stimulates growth of linear bone, skeletal muscle, and organs. Stimulates erythropoietin, which increases red blood cell mass.

Currently widely available in SC injection form. Adjust dose gradually based on clinical and biochemical responses assessed at monthly intervals, including body weight, waist circumference, serum IGF-1, IGFBP-3, serum glucose, lipids, thyroid function, and whole body dual-energy x-ray absorptiometry. In children, assess response based on height and growth velocity. Continue treatment until final height or epiphysial closure or both have been recorded. Increasing evidence indicates that GH replacement is also beneficial in deficient adults.

Testosterone (Androderm, AndroGel, Andro-LA, Delatest, Depo-Testosterone)

 

This is used for induction of puberty in hypopituitary males. In the fully developed male, testosterone patches at 5 mg/d provide the advantage of more even control, although some adolescents are uncomfortable wearing them. Administer low-dose testosterone over 1-2 mo to the prepubertal male with gonadotropin deficiency and microphallus who is embarrassed by the small size or the inability to urinate in a standing position.

Conjugated estrogens (Premarin)

 

This drug is used for initiation of puberty in girls with hypogonadotropism. Continue everyday treatment until breakthrough menstrual bleeding occurs and then initiate cyclical therapy. This can be achieved with any of the various PO contraceptives or the addition of medroxyprogesterone 5 mg to an estradiol regimen during the third wk of every mo with no treatment the last wk. PO contraceptive treatment is easier for patient to follow. Instead of Premarin, ethinyl estradiol (Estrace) can be used.

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Estrogen Derivative

Class Summary

These medications are used for replacement of deficient hormones.

Estradiol

 

Estradiol restores estrogen levels in girls with hypogonadotropism to concentrations that induce negative feedback at gonadotrophic regulatory centers, which, in turn, reduces release of gonadotropins from pituitary.

Multiple studies have shown it will prevent bone loss at the spine and hip when started within 10 years of menopause.

Estradiol is used for the purpose of hormone replacement and induction of puberty. It acts by regulating 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

Robert P Hoffman, MD Professor and Program Director, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Pediatric, Endocrinology, Diabetes, and Metabolism, Nationwide Children's Hospital

Robert P Hoffman, MD is a member of the following medical societies: American College of Pediatricians, American Diabetes Association, American Pediatric Society, Christian Medical and Dental Associations, Endocrine Society, Midwest Society for Pediatric Research, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Lynne Lipton Levitsky, MD Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard Medical School

Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Received grant/research funds from Eli Lilly for pi; Received grant/research funds from NovoNordisk for pi; Received consulting fee from NovoNordisk for consulting; Partner received consulting fee from Onyx Heart Valve for consulting.

Chief Editor

Stephen Kemp, MD, PhD Former 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, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Thomas A Wilson, MD Professor of Clinical Pediatrics, Chief and Program Director, Division 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, Pediatric Endocrine Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

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Pathophysiology of panhypopituitarism.
 
 
 
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