[Pharmacotherapy of pituitary diseases]

Abstract

Successful pharmacotherapy of pituitary hormonal excess is established only in the treatment of acromegaly (dopamine agonists, somatostatin analogues, GH-receptor-antagonists) and of prolactinomas (dopamine agonists). Gold standard in the treatment of acromegaly is transsphenoidal pituitary surgery, while in prolactinomas, surgery is indicated only in exceptional cases. Substitution of pituitary insufficiency offers the patients a normal quality of life. Substitution of the cortico- and thyrotrope axis with hydrocortisone and levothyroxine is vital. In women, substitution of the gonadotrope axis should be performed up to menopause (estrogen/gestagen). In men, substitution should be performed lifelong (trans-dermal testosterone body patches, testosterone gel, testosterone undecanoate/enanthate). To achieve fertility, gonadotropins or pulsatile GnRH therapy has very good results. Especially in younger patients, substitution of growth hormone may be useful (somatropin).