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Hypothalamic-Pituitary Axis01:37

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The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
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Hormones of the Pituitary Gland01:27

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The small, pea-sized pituitary gland is located at the base of the brain. It is crucial in regulating various bodily functions, from growth to reproduction. The gland is divided into the anterior lobe and the posterior lobe. The secretory cell clusters in the pars distalis of the anterior pituitary lobe are controlled by hypothalamic regulators and synthesize six primary hormones.
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The pituitary is a small endocrine organ in the sphenoid bone under the hypothalamus. Primarily, the pituitary in adults has two distinct anatomical and functional regions— the anterior and posterior lobes. During human fetal development, a third pituitary gland region called the pars intermedia atrophies and disappears. However, some of its cells migrate and exist adjacent to the anterior pituitary in adults.
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Adrenergic Agonists: Therapeutic Uses01:30

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Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
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Dopamine Agonists for Pituitary Adenomas.

Odelia Cooper1, Yona Greenman2

  • 1Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

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|September 7, 2018
PubMed
Summary

Dopamine agonists effectively treat prolactinomas by targeting dopamine 2 receptors. Research shows these drugs offer some benefit for Cushing's disease, acromegaly, and nonfunctioning pituitary tumors.

Keywords:
Cushing's diseaseacromegalydopamine agonistnonfunctioning pituitary tumorpituitary adenoma

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Area of Science:

  • Endocrinology
  • Neuro-oncology
  • Pharmacology

Background:

  • Dopamine agonists (DA) are the primary treatment for prolactinomas due to high dopamine 2 receptor (D2R) expression.
  • D2R are present in other pituitary tumors, prompting investigation into off-label DA use.

Purpose of the Study:

  • To review the efficacy of dopamine agonists in non-prolactinoma pituitary tumors.
  • To evaluate DA's role in Cushing's disease, acromegaly, and nonfunctioning pituitary tumors (NFPT).

Main Methods:

  • Review of preclinical models and clinical studies on DA for pituitary tumors.
  • Analysis of hormonal normalization and tumor response rates in various pituitary tumor types.

Main Results:

  • DA therapy normalizes urinary cortisol in ~25% of Cushing's disease patients; tumor shrinkage is minimal.
  • DA therapy normalizes IGF-I and shrinks tumors in ~33% of acromegaly patients, with better results combined with somatostatin receptor ligands.
  • For NFPT, DA therapy resulted in tumor size reduction in 30% and stabilization in 58% of patients.

Conclusions:

  • Dopamine agonists demonstrate clinical benefits in non-prolactinoma pituitary tumors.
  • DA therapy may be a viable medical option for specific pituitary tumor subtypes beyond prolactinomas.