Treatment Options for Pituitary Tumor / Hormone Replacement Therapy
Pituitary Tumor & Neuroendocrine
Disorders
General
Information
- Pituitary
malfunction can cause deficiencies in specific hormones with a wide range of
symptoms and treatment options.
- All patients
who require long-standing cortisol, thyroid and/or DDAVP replacement should
wear a "med-alert" bracelet at all times to notify medical personnel in case
of illness or trauma.
Deficiencies
- Deficiency
of adrenocorticotropic hormone (ACTH) and cortisol: The most
dangerous and life-threatening deficiency.
- Symptoms: Symptoms include weakness, nausea,
abdominal and joint aches, electrolyte abnormalities, low blood pressure and
shock.
- Treatment: Replacement therapy consists of
administering cortisol. Prednisone and hydrocortisone are the most common oral
preparations of cortisol. The dosage may need to be temporarily increased
during periods when the body is stressed because of illness, infection,
surgery or trauma.
- Deficiency
of TSH and thyroid hormone
- Symptoms: Symptoms of thyroid hormone deficiency
include cold intolerance, dry skin, constipation, muscle aches, menstrual
irregularities and weight gain. The combination of symptoms is very
uncomfortable and often drives patients with pituitary disease to seek medical
attention.
- Treatment: Replacement therapy consists of giving
thyroxine (marketed as Synthroid™, Levoxyl™, or Levothroid™). Blood levels are
closely monitored as over-replacement may cause complications such as
osteoporosis or heart disease.
- Deficiency
of luteinizing hormone (LH) or follicle stimulating hormone (FSH):
Results in low estrogen levels in women and low testosterone in men.
- Symptoms: Symptoms range from "hot flashes" to
low sex drive. These hormones also have protective effects on bone.
- Treatment: Estrogen can be given orally as
premarin or estrace, or can be given as a twice weekly patch. Women taking
estrogen also need to take progesterone, unless they have had a hysterectomy.
Progesterone has protective effects on the uterus. Progesterone can be given
orally as Provera™ or as a patch. (CombiPatch™ contains both estrogen and
progesterone.). In men, testosterone is administered either via bi-weekly
injection into the muscle at home or daily skin patch. Testosterone patch
(marketed as Testoderm TTS™) is more costly but has the advantage of
maintaining more even androgen levels. Skin rash is a rare side-effect.
- Growth
hormone (GH) deficiency: Generally, all children with GH deficiency
should receive replacement therapy. However, GH therapy in adults is more
controversial. The use of GH to treat GH-deficient adults was approved by the
Food and Drug Administration in August 1996.
- Symptoms: There is some evidence that GH
deficiency in adults may increase risk of death from vascular disease. GH
deficiency also results in decreased lean body mass and may also have negative
psychological effects.
- Treatment: GH is administered via daily
injection. The long-term effects of GH treatment in adults are currently being
studied.
- Vasopressin
(ADH) deficiency
- Symptoms: Lack of ADH causes diabetes insipidus,
with excessive thirst and urination. Patients may become severely dehydrated
if they do not drink enough liquid.
- Treatment: ADH is currently replaced by
administration of DDAVP, a synthetic version of the hormone, by pill, nasal
spray or injection.
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