Disturbances in endocrine function, such as hormone production, are common in patients with pituitary disorders. Physicians in our center have extensive experience helping patients to manage syndromes resulting from hormone overproduction, including amenorrhea-galactorrhea syndrome, Cushing’s syndrome, acromegaly, and TSH-mediated hyperthyroidism.

We take care to devise evidence-based strategies for the preoperative and postoperative medical management of all of these hormone syndromes based on individual patient needs. Our neuroendocrinologists have particular expertise in developing and implementing treatment plans for patients with acromegaly and Cushing’s disease who did not benefit from surgery or who are not surgical candidates.

Our neuroendocrinologists also have considerable experience in the careful and precise management of hormone replacement in patients with abnormalities or loss of pituitary function and diabetes insipidus. Treatment and consultation with specialists in reproductive endocrinology are available for pituitary disorders affecting fertility in both men and women. Children with pituitary disorders are treated under the care of a full multidisciplinary team, including pediatric specialists. In order to continually improve upon treatment options for our patients, we are involved in pursuing investigative strategies and experimental therapeutic approaches are available for selected patients.

 

 

Cortisol Replacement

Without cortisol, a person can die. In times of stress, illness or injury, the steroid dose should be increased to meet the body’s greater need. If you fail to do this, it could lead to life-threatening low blood pressure. In the event of an illness that affects your entire body, you should increase your dose of steroids and call your doctor.

If you are on cortisol replacement therapy, you should wear a medic alert bracelet or necklace to alert paramedics or doctors about your need for steroids in the event you are found unconscious.

Side Effects of Cortisol Replacement Therapy

If the dose of steroids is too high, the results may include:

• Weight gain
• A rounded face
• Acne
• High blood pressure
• Abnormal blood sugars

 

Growth Hormone Replacement

Replacing growth hormones that lacking or missing can improve the quality of life of a person who has growth hormone deficiency. It reduces body fat and increases the density of bones.

Growth hormone replacement therapy is not appropriate for people who have active cancer or certain types of eye damage as a result of diabetes (diabetic retinopathy).

If after being on growth hormone replacement for six months without any clinical improvement, the therapy should be stopped. Ongoing, long-term studies are evaluating the benefits and risks of growth hormone replacement therapy.

Side Effects of Growth Hormone Replacement

Be aware that growth hormone can affect the way the body uses insulin. If you are a diabetic who is receiving growth hormone replacement therapy, be sure to inform your doctors and regularly monitor your blood sugar and manage your diabetes well.

In addition, growth hormone replacement therapy can cause:

• Water retention
• Achy joints and muscles
• Carpel tunnel syndrome (pins and needles in the fingers and toes)

 

Drug Therapy for Prolactinomas

The first treatment of choice for people who have prolactinomas is dopamine agonist therapy (DA). This therapy, which includes the use of cabergoline (dostinex) and bromocriptine (parladel) to block the secretion of prolactin. This brings the level of prolactin in the blood down to normal levels and often shrinks the tumor.

After starting the dopamine agonist therapy, patients are followed up at one to three month intervals until they are stable. The dosage given is adjusted on the basis of how prolactin levels change in response. After two years of therapy, an endocrinologist may try to reduce the dosage.

Magnetic resonance imaging should be repeated after three to six months and then again as the patient’s symptoms and conditions indicate.

Side Effects for Dopamine Agonist Therapy

This therapy can cause nausea, vomiting and a loss of blood pressure when standing. This can make a person feel light headed or dizzy.

A woman who is pregnant should consider bromoctiptine for the therapy rather than cabergoline. Bromoctiptine has been established as being safe to use during pregnancy, while cabergoline has not.

 

Sex Steroid Hormone Replacement

As the master gland, the pituitary gland controls sex hormones among others. Hormone replacement considerations for women and men with pituitary disorders or conditions are described below.

Hormone Replacement for Women with Pituitary Disorders

Women who have pituitary disorders that affect the production of sex steroids should consider hormone replacement as described below:

• Women who have not yet gone through menopause should consider estrogen replacement with or without progesterone
• Women who have gone through menopause should consider estrogen/progesterone replacement on the same basis as women without hypotuitarism

If the lack of sex steroid has been long standing, estrogen replacement should be gradual to avoid side-effects such as nausea and painful breasts. Some of the side effects of hormone replacement for women include:

• Breast swelling
• Heavy menstrual bleeding
• Breakthrough bleeds (bleeding between periods)
• Blood clots

Without hormone replacement, a woman with a pituitary disorder may have:

• Osteoporosis
• Possible early heart disease
• Decrease in breast and uterine size
• Intertility
• A loss of interest in sex (libido)

Hormone Replacement for Men with Pituitary Disorders

Men with a pituitary disorder that causes hypogonadism should have testosterone replacement therapy. This can be given as a shot into the muscles every two to three weeks or as a skin patch or gel.

Testosterone replacement therapy can cause acne, breast enlargement (gynecomastia), lowered HDL cholesterol (the desirable cholesterol) and a higher red blood cell count.

There is a risk of prostate enlargement with testosterone replacement. Older men should have a PSA monitoring test every three to six months and then annually if there are no signs of prostate abnormalities.

Testosterone leves should be monitored at the four to six week point, the six month point and then annually unless test results suggest that more frequently monitoring is necessary.

 

Thyroid Hormone Replacement

People whose bodies are not making enough thyroid hormone will feel tired, gain weight, be sensitive to cold and have dry skin, a poor memory and a slow heart beat.

Thyroid replacement should only be started after you have been tested for a lack of steroids. When this has been ruled out – or after steroid replacement therapy has been started, if tests show it is needed – then thyroid hormone replacement can be done.

Side Effects of Thyroid Hormone Replacement

Side effects only usually show up when you have been given too much thyroid hormone. The effects then include anxiety, a fast heart beat and tremor (a shakiness of the muscles that you cannot control).

If a person has blocked heart vessels and is given too much thyroid hormone, he or she may have chest pain or an abnormal heart rhythm. People who are at risk for heart conditions should be started on low doses of thyroid hormone. The dose should be increased slowly as needed.

 

Vasopressin Replacement

Either a total or partial lack of the hormone vasopressin can cause diabetes insipidus. This is a condition in which the kidneys are not able to retain water, causing a person to urinate frequently resulting in excessive thirst which causes patients to drink enormous amounts of water.

If vasopressin replacement is not done, a person will pass large amounts of dilute urine and be very thirsty and drink massive amounts of water. Eventually, the person becomes dehydrated, loses consciousness and can die.
Vasopressin replacement is usually done by giving desmopressin, a synthetic version of vasopressin in a nose spray or a tablet. It lasts 12 to 24 hours.

Because individuals vary widely, it is necessary to measure how long a specific dose will be effective. By measuring the amount of urine voided and how diluted it is, the proper dosage can be identified. . If the water loss is mild,. and does not interfere with sleep, patients can be encouraged to drink until their thirst resolves and may require no treatment

Side Effects of Vasopressin Replacement

If too much vasopressin is administered, patients develop a low blood salt, which can result in headache, nausea, vomiting, confusion and unconsciousness. If too little vasopressin is administered, patients pass very large volumes of urine, become thirsty and drink excessive amounts of water, resulting in sever dehydration and increase in blood salt.