Pediatric Hypopituitarism Medication

Updated: Nov 02, 2015
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: Stephen Kemp, MD, PhD  more...
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Medication

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.

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.

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.

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

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

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.

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.

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.

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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