RT Book, Section
A1 Jordan, Joseph K.
A1 Sheehan, Amy Heck
A1 Munir, Kashif
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182461759
T1 Pituitary Gland Disorders
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182461759
RD 2024/04/19
AB KEY  CONCEPTS  Pharmacologic  therapy  for  acromegaly  should  be  considered  when  surgery  and  irradiation  are  contraindicated,  when  there  is  a  poor  likelihood  of  surgical  success,  when  rapid  control  of  symptoms  is  needed,  or  when  other  treatments  have  failed  to  normalize  growth  hormone  (GH)  and  insulin-like  growth  factor-1  (IGF-1)  serum  concentrations.  Pharmacotherapy  for  acromegaly  using  dopamine  agonists  has  several  advantages  including  oral  administration  and  lower  cost  when  compared  to  somatostatin  analogs  and  pegvisomant.  However,  dopamine  agonists  effectively  normalize  IGF-1  serum  concentrations  in  only  10%  to  30%  of  patients.  Therefore,  somatostatin  analogs  remain  the  mainstay  of  therapy.  Blood  glucose  concentrations  should  be  monitored  frequently  in  the  early  stages  of  somatostatin  analog  therapy,  especially  pasireotide.  Pegvisomant  appears  to  be  the  most  effective  agent  for  normalizing  IGF-1  serum  concentrations.  Recombinant  growth  hormone  (GH)  is  currently  considered  the  drug  of  choice  for  the  treatment  of  children  with  growth  hormone–deficient  short  stature.  Prompt  diagnosis  of  growth  hormone  deficiency  (GHD)  and  initiation  of  replacement  therapy  with  recombinant  GH  is  crucial  for  optimizing  final  adult  heights.  All  GH  products  are  equally  effective.  The  recommended  initial  dose  for  treatment  of  GHD  short  stature  in  children  is  0.16  to  0.24  mg/kg/wk.  Pharmacologic  agents  that  antagonize  dopamine  or  increase  the  release  of  prolactin  can  induce  hyperprolactinemia.  Discontinuation  of  the  offending  medication  and  initiation  of  an  appropriate  therapeutic  alternative  usually  normalizes  serum  prolactin  concentrations.  Cabergoline  appears  to  be  more  effective  than  bromocriptine  for  the  medical  management  of  prolactinomas  and  offers  the  advantage  of  less-frequent  dosing  and  fewer  adverse  effects.  Although  preliminary  data  do  not  suggest  that  cabergoline  has  significant  teratogenic  potential,  cabergoline  is  not  recommended  for  use  during  pregnancy.  Patients  receiving  cabergoline  or  bromocriptine  who  plan  to  become  pregnant  should  discontinue  the  medication  as  soon  as  pregnancy  is  detected.  Pharmacologic  treatment  of  panhypopituitarism  includes  the  use  of  glucocorticoids,  thyroid  hormone,  sex  steroids,  and  recombinant  GH,  when  appropriate,  as  lifelong  replacement  therapies.