[Therapy of pituitary diseases. What can be achieved with medication and hormones?]

Pharmacotherapy is available only for pituitary adenomas producing growth hormone and prolactin (acromegaly, hyperprolactinemia). While dopamine agonists and somatostatin analogues are usually administered to acromegaly patients only after unsuccessful surgery, dopamine agonists are the treatment of choice in patients with prolactinomas. Replacement treatment in patients with insufficiency of the anterior lobe of the hypophysis is oriented to the extent of the deficits. Theoretically, replacement treatment can be applied for any functional loss. Of essential importance is the replacement of lost adrenal cortical function by the regular administration of physiological doses of hydrocortisone, and of lost thyroid function by the administration of L-thyroxine. In high-stress situations, for example, due to severe illness, the hydrocortisone dose must be increased significantly, and if necessary given parenterally. Gonadal function is replaced either with gonadal steroid hormones or gonadotropin or GnRH in patients wishing to have children. In adults, replacement of growth hormone is also indicated to decrease cardiovascular risk. This, however is very expensive and requires s.c. injections.