Hyperpituitarism Medication

Updated: Jun 30, 2020
  • Author: Alicia Diaz-Thomas, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Medication

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.

Bromocriptine (Parlodel)

Most often used to treat GH and PRL excess.

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.

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).

Lanreotide (Somatuline Depot)

Pasireotide (Signifor, Signifor LAR)

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Growth hormone receptor antagonists

Class Summary

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

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.

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.

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.

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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