ANTERIOR PITUITARY HYPOFUNCTIORI: HYPOPITUITARISM - Treatment



Treatment of patients with panhypopituitarism consists of replacement of the specific hormone deficiencies with glucocorticoid, thyroxine, and the appropriate gonodal steroid. Growth hormone replacement is indicated in children who have not reached adult stature. Growth hormone and pro­lactin deficiencies in adults require no specific therapy. Restoration of fertility in women with hypopituitarism is theoretically possible with a combination of human menopausal gonadotropin and chorionic gonadotropin and by GnRH therapy in cases in which the lesion is in the hypothala­mus or pituitary stalk.

Special precautions are required when initiat­ing hormonal replacement therapy in patients with panhypopituitarism. Administration of thy­roxine in patients who have concomitant ACTH deficiency can result in an increase in the meta­bolic clearance rate of glucocorticoid hormones and the sudden precipitation of an Addisonian crisis. Accordingly, such patients should always receive glucocorticoid therapy at the same time or preceding the onset of thyroid hormone replace­ment. Initiation of therapy with glucocorticoid hormones and thyroxine can unmask co existing diabetes insipidus by improving free water clear­ance in patients with combined anterior and pos­terior pituitary insufficiency. Such patients may require concomitant treatment with antidiuretic hormone, as discussed in a subsequent section.





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