Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-25T05:21:27.941Z Has data issue: false hasContentIssue false

The Medical Treatment of the Hypersecreting Pituitary Gland

Published online by Cambridge University Press:  18 September 2015

Bernard Corenblum*
Affiliation:
Department of Medicine, Faculty of Medicine. The University of Calgary
*
Room 1412, Health Sciences Centre, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Pituitary adenomas may produce local endocrine and neurological effects, as well as systemic metabolic complications due to hormonal hypersecretion. Medical therapy with pharmacological agents has been developed and is based on the neurotransmitter regulation of normal pituitary hormonal secretion. 189 patients with secretory pituitary adenomas underwent medical therapy for the hypersecretory state. 156 of these were prolactin-secreting adenomas, 16 of which were in males. The response of bromocriptine was almost universal with lowering of serum prolactin and reversal of the clinical symptoms, as well as tumor shrinkage of most large adenomas with suprasellar extension. 23 patients with acromegaly were treated with bromocriptine, with 11 noting clinical improvement, and decreased tumor size in two. Five patients with Cushing’s disease were treated with cyproheptadine, with only one showing a biochemical and clinical improvement. Two patients with Nelson’s syndrome each had progressive tumor growth stabilized with cyproheptadine and bromocriptine in one, and sodium valproate in the other. There appears to be a role for medical therapy in the majority of prolactin-secreting pituitary tumors, some growth hormone secreting pituitary tumors, and selected adrenocorticotropin secreting-pituitary tumors.

Type
Original Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1985

References

REFERENCES

Acs, Z, Stark, E (1978) Possible role of gamma-aminobutyric acid synthesis in the mechanism of dexamethasone feedback action. J Endocrinol 77: 137141.CrossRefGoogle ScholarPubMed
Allolio, B, Winkelmann, W, Laulen, D, Hipp, FX, Mies, R (1982) Valproate in Cushing’s syndrome. Lancet 1: 171.CrossRefGoogle ScholarPubMed
Atkinson, AB, Allen, IV, Gordon, DS, Hadden, DR, Maguire, CJF, Trimble, ER, Lyons, AR (1979) Progressive visual failure in acromegaly following external pituitary irradiation. Clin Endocrinol 10:469479.CrossRefGoogle ScholarPubMed
Breidahl, HD, Topliss, DJ, Pike, JW (1983). Failure of bromocriptine to maintain reduction in size of a macroprolactinoma. Br Med J 287: 451452.CrossRefGoogle ScholarPubMed
Burrow, GN, Wortzman, G, Rewcastle, NB, Holgate, RC, Kovacs, K (1981) Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 304: 156158.CrossRefGoogle Scholar
Chiodini, PG, Liuzzi, A, Botalla, G, Cremascoli, G, Silvestrini, F (1974) Inhibitory effect of dopaminergic stimulation on GH release in acromegaly. J Clin Endocrinol Metab 38: 200206.CrossRefGoogle ScholarPubMed
Corenblum, B, Webster, BR, Mortimer, CB, Erzin, C (1975) Possible anti-tumor effect of 2-bromo-ergocryptine in two patients with large prolactin-secreting pituitary tumors. Clin Res 23: 614.Google Scholar
Corenblum, B, Sirek, AMT, Horvath, E, Kovacs, K, Erzin, C (1976) Human mixed somatotrophic and lactotrophic pituitary adenomas. J Clin Endocrinol Metab 42: 857863.CrossRefGoogle ScholarPubMed
Corenblum, B (1979) Role of dynamic pituitary testing in patients with hyperprolactinemia. Diagn Gynecol Obstet 1: 153164.Google Scholar
Corenblum, B, Hanley, DA (1981) Bromocriptine reduction of prolactinoma size. Fertil Steril 36: 716719.CrossRefGoogle ScholarPubMed
Corenblum, B, Taylor, PJ (1983) Long-term follow-up of hyperprolactinemic women treated with bromocriptine. Fertil Steril 40: 596599.CrossRefGoogle ScholarPubMed
Costello, RT (1936). Subclinical adenoma of the pituitary gland. Am J Pathol 12:205215.Google ScholarPubMed
Dornhorst, A, Jenkins, JS, Lamberts, SWJ, Abraham, RR, Wynn, V, Beckford, U.Gillham, B, Jones, MT (1983) The evaluation of sodium valproate in the treatment of Nelson’s syndrome. J Clin Endocrinol Metab. 56:985991.CrossRefGoogle ScholarPubMed
Elias, AN, Gwinup, G, Valenta, LJ (1981) Effects of valproic acid naloxone, and hydrocortisone in Nelson’s syndrome and Cushing’s disease. Clin Endocrinol 15: 151154.CrossRefGoogle ScholarPubMed
Faglia, G, Moriondo, P, Travaglini, P, Giovanelli, MA (1973) Influence of previous bromocriptine therapy on surgery for microprolactinoma. Lancet 1: 133134.Google Scholar
Franks, S, Horrocks, PM, Lynch, SS, Butt, WR, London, DR (1983) Effectiveness of pergoline mesylate in long term treatment of hyperprolactinaemia. Br Med J 286: 11771179.CrossRefGoogle ScholarPubMed
Friesen, HG, Tolis, G (1977) The use of bromocriptine in the galactorrheaamenorrhea syndrome: the Canadian cooperative study. Clin Endocrinol 6 (Suppl) 9199.CrossRefGoogle Scholar
Horn, K, Erhardt, F, Fahlbusch, R, Pickardt, CR, Weder, K, Scriba, PC (1976) Recurrent goiter, hyperthyroidism, galactorrhea and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 43: 137143.CrossRefGoogle ScholarPubMed
Ishibashi, M, Yamaji, T (1981) Direct effects of thyrotropin-releasing hormone, cyproheptadine, and dopamine on adrenocorticotropin secretion from human corticotroph adenoma cells in vitro. J Clin Invest 68: 10181027.CrossRefGoogle ScholarPubMed
Johnston, DG, McGregor, A, Ross, WM, Hall, R (1981) Bromocriptine therapy for “non-functioning” pituitary tumors. Am J Med 71: 10511061.CrossRefGoogle Scholar
Jones, MT, Hillhouse, EW, Burden, J (1976) Effect of various putative neurotransmitters on the secretion of corticotrophin-releasing hormone from the rat hypothalamus in vitro – a model of the neurotransmitters involved. J Endocrinol 69, 110.CrossRefGoogle Scholar
Jones, MT, Gillam, B, DiRenzo, G, Beckford, U, Holmes, MC (1981). Neural control of corticotrophin secretion. Front Horm Res 8: 1243.CrossRefGoogle Scholar
Kendall-Taylor, P, Hall, K, Johnston, DG, Prescott, RWG (1982) Reduction in size of prolactin-secreting tumors in men treated with pergolide. Br Med J 285: 465467.CrossRefGoogle ScholarPubMed
Koppeschaar, HPF, Croughs, RJM, Thijssen, JHH, Schwarz, F (1982) Sodium valproate and heterogeneity of the pituitary dependent Cushing’s syndrome. Lancet 1: 1253.Google ScholarPubMed
Koppeschaar, HPF, Croughs, RJM, Thijssen, JHH, Scwartz, F (1983) Sodium valproate and cyproheptadine may independently induce remission in the same patient with Cushing’s disease. Acta Endocrinol 104: 160163.Google ScholarPubMed
Krieger, DT (1983) Physiopathology of Cushing’s disease. Endocrine Rev 4: 2243.CrossRefGoogle ScholarPubMed
Lamberts, SWJ, Klijn, JGM, de Quijada, M, Timmermans, HAT, Uitterlinden, P, de Jong, FH, Birkenhager, JC (1980) The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing’s disease and Nelson’s syndrome. J Clin Endocrinol Metab. 51: 307311.CrossRefGoogle ScholarPubMed
Lamberts, SWJ, de Lange, SA, Stefanko, SZ (1982) Adrenocorticotropin-secreting pituitary adenomas originate from the anterior or the intermediate lobe in Cushing’s disease: differences in the regulation of hormone secretion. J Clin Endocrinol Metab 54: 286291.CrossRefGoogle ScholarPubMed
Landolt, AM, Kellar, PJ, Froesch, ER, Mueller, J (1982) Bromocriptine: does it jeopardise the result of later surgery for prolactinomas? Lancet 3: 657658.CrossRefGoogle Scholar
Moore, TJ, Dluhy, RG, Williams, GH, Cain, JP (1976) Nelson’s syndrome: frequency, prognosis, and effect of prior pituitary irradiation. Annals Int Med 85: 731734.CrossRefGoogle ScholarPubMed
Plonk, JW, Bivens, CH, Feldman, JH (1974) Inhibition of hypoglycemia-induced Cortisol secretion by the serotonin antagonist cyproheptadine. J Clin Endocrinol Metab 38: 836840.CrossRefGoogle ScholarPubMed
Plonk, J, Feldman, JM (1976) Modification of adrenal function by the antiserotonin agent cyproheptadine. J Clin Endocrinol Metab 42: 291295.CrossRefGoogle Scholar
Serri, O, Radio, E, Beauregard, H, Hardy, J, Somma, M (1983) Recurrence of hyperprolactinemia after selective transsphenoidal adeneclomy inwomen with prolactinoma. N Engl J Med 309: 280283.CrossRefGoogle Scholar
Stubbs, WA, Delitala, G, Jones, A, Jeffcoate, WJ, Edwards, CRW, Rees, LH, Besser, GM (1978) Hormonal and metabolic responses to an enkephalin analogue in normal man. Lancet 4: 12251227.CrossRefGoogle Scholar
Tindall, GT, Kovacs, K, Horvath, E, Thorner, MO (1982) Human prolactin-producing adenomas and bromocriptine: a histological, immuno-cytochemical, ultrastructural, and morphometric study. J Clin Endocrinol Metab 55: 11781183.CrossRefGoogle Scholar
Tolis, G, Juckier, L, Wiesen, M, Krieger, DT (1982) Effect of naloxone on pituitary hypersecretory syndromes. J Clin Endocrinol Metab 54: 780784.CrossRefGoogle ScholarPubMed
Turkal, I, Braun, P, Krupp, P (1982) Surveillance of bromocriptine in pregnancy. JAMA 247: 15891591.CrossRefGoogle Scholar
Volker, W, Gehring, WG, Berning, R, Schmidt, RC, Schneider, J, Von Zur Muhlen, A (1982) Impaired pituitary response to bromocriptine suppression: reversal after bromocriptine plus tomoxifen. Acta Endocrinol 101: 491500.Google Scholar
Wass, JAH, Thorner, MO, Morris, DV, Rees, LH, Mason, AS, Jones, AE, Besser, GM (1977) Long-term treatment of acromegaly with bromocriptine. Br Med J 1: 875878.CrossRefGoogle ScholarPubMed
Wass, JAH, Clemmons, DR, Underwood, LE, Barrow, I, Besser, GM, Van Wyk, JJ (1982) Changes in circulating somatomedin-C levels in bromocriptine-treated acromegaly. Clin Endocrinol 17: 369377.CrossRefGoogle ScholarPubMed
Nass, JAH, Besser, GM (1983) The medical management of hormone-secreting tumors of the pituitary. Ann Rev Med 34: 283294.Google Scholar
Wollesen, F, Anderson, T, Karle, A (1982) Size reduction of extrasellar pituitary tumors during bromocriptine treatment. Annals Int Med 96: 281286.CrossRefGoogle ScholarPubMed