Treatment

Treatment for Growth Hormone Deficiency (GHD)

Click here to view Diagnosis of Growth Hormone Deficiency

If any of your other pituitary hormones are lacking, your endocrinologist must treat these first, and only start GH treatment when these other hormones are at the right level.

Injections

You will be given injection pens to inject yourself daily. A pituitary nurse will show you how to do this.

Side effects

GH increases the amount of fluid in your body. Possible effects of GH treatment are muscle or joint pain, headaches, blurred vision, swelling, or pain and numbness in the hands. Your doctor will lower the GH dose temporarily if these occur. GH treatment can also increase blood sugar levels.

Monitoring

You will have your blood checked every four to eight weeks by your doctor, to check if more GH is needed, or less. Your cholesterol and bone density will also be monitored. These should improve with GH treatment.

Repeat questionnaire

After nine months you will be given the same AGHDA quality of life questionnaire which you filled in before treatment. If your quality of life has improved by seven points since then, your treatment will be continued for the rest of your life.

(The above information is taken from the websites of the Pituitary Foundation, Cedars-Sinai, You and Your Hormones (Society for Endocrinology) and the Cleveland Clinic.)

Treatment for Cortisol Deficiency

Click here to view Diagnosis of Cortisol Deficiency

Medication

Your cortisol will be replaced with hydrocortisone, to be taken several times a day by mouth. You may find that careful fine-tuning of the timing and amount of your dose to imitate your body’s natural rhythms will help you, see https://www.pituitary.org.uk/support-for-you/peer-support/patient-stories/gail%E2%80%99s-story-hydrocortisone-regime/

Alternatively, less commonly, you may be prescribed prednisone or dexamethasone.

Sick day rules

There are times when your body will need extra cortisol, eg before surgery or when you have a fever, infection or gastric upset. It is important to follow ‘sick day rules’ (see the Pituitary Foundation website), always to carry a medical alert card and bracelet, and to keep some medication handy wherever you are. This is to avoid an adrenal crisis, which can be life-threatening.

Adrenal crisis

If you do have an adrenal crisis you will be given an emergency injection of hydrocortisone, sugar and saline solution.

(The above information has been taken from the websites of the Pituitary Foundation, the Mayo Clinic and NICE.)

Treatment for Sex Hormone Deficiency (Secondary Hypogonadism)

Click here to view Diagnosis of Sex Hormone Deficiency

For males

Testosterone replacement

You will usually be treated with testosterone replacement to return testosterone levels to normal. You may be treated with intramuscular injections given anywhere from two to 10 weeks apart, gel, patches, pellets under the skin, testosterone stick or material that you lodge above your gums.

Effects

You will hopefully notice an improvement in your sexual desire, energy, facial and body hair, muscle and bone density.

Monitoring

You should be monitored several times during the first year and then annually.

Side effects

Possible side effects are increased production of red blood cells, acne, enlarged breasts, sleep disturbances, prostate enlargement, and limited sperm production.

Treatment for infertility

Testosterone replacement alone will not restore fertility. For this you need replacement LH and FSH, usually as human chorionic gonadotrophin (hCG) and human menopausal gonadotrophin (hMG). The injections may be given two to three times a week, for up to two years, to build up sperm production. The Pituitary Foundation’s leaflet ‘Male Hormones and Infertility Issues’ gives a full and helpful account of testosterone replacement and infertility treatment.

For females

Estrogen, progesterone, testosterone

You will be treated with estrogen by patch or pill, plus progesterone if you have not had a hysterectomy. You may also have low doses of testosterone if your sex drive has decreased.

Effects

Hopefully your bone strength will improve, your sex drive will be supported and your cholesterol levels will get better.

For infertility

You will be treated with human choriogonadotropin or FSH pills to trigger ovulation.

If you have a pituitary tumour
If your MRI shows a pituitary tumour you will receive radiation, medication or surgery.

Further information can be found on the websites for the Pituitary Foundation, the Mayo Clinic and Your Hormones

Treatment for Thyroid Hormone Deficiency (Hypothyroidism)

Click here to view Diagnosing Thyroid Hormone Deficiency

The treatment will usually be levothyroxine tablets taken daily. Levothyroxine is a synthetic version of the thyroxine hormone. The dose will have to be adjusted to suit you, usually starting low and increasing gradually. You will have blood tests after 6-8 weeks while the dose is calibrated, then annual monitoring.

The effects are likely to be that your cholesterol levels will go down and any weight gain will be reversed. Treatment will probably be lifelong.

Note

Some people do not respond well to levothyroxine because their body does not convert T4 (thyroxine) to T3 (triiodothyronine) well. T3 is the active form of thyroid hormone, and some doctors will prescribe this if it seems necessary. Diet also plays a role in the absorption of thyroxine.

If your symptoms do not seem to be helped by either levothyroxine or triiodothyronine, it is worth considering whether you have been properly investigated for growth hormone deficiency, which like hypothyroidism also causes tiredness, weight gain and depression.

The Thyroid UK forum (part of the Health Unlocked website) is a mine of helpful advice. Further information can be found on the NHS website and the Mayo Clinic website.

Treatment for Arginine Vasopressin Deficiency (AVD) (Diabetes Insipidus)

Click here to view Diagnosis of Arginine Vasopressin Deficiency (AVD)

If your diabetes insipidus is only mild, you will be advised to drink more water. If your condition is caused by, for example, a tumour in your pituitary or hypothalamus, you will first receive treatment for this.

Then if the DI continues you will be given desmopressin, which is a synthetic form of ADH (anti-diuretic hormone) and can be taken in tablet form, as a nasal spray or by injection. This will reduce the amount of urine you produce. However it is important to get the dose right as too much desmopressin may cause water retention and low blood sodium, which can be serious.

Another possible medication is chlorpropamide, which makes ADH more available in your body.

Note

Problems in your pituitary or hypothalamus are not the only possible cause of diabetes insipidus. It can be caused by failure of your kidneys to respond to ADH, in which case the treatment will be different.

Further information can be found on the websites for the NHS, the Pituitary Foundation, the Mayo Clinic and Your Hormones.

If your prolactin excess is caused by thyroid deficiency, your thyroid levels will be restored by thyroid replacement medicine and this will also cause your prolactin level to normalise.

If your regular medicine is the reason for your high prolactin levels, your doctor will try you on a different medicine or add one to help your prolactin levels go down.

If no cause is found or you have a pituitary tumour, the usual treatment is medicine, which will most commonly be cabergoline or bromocriptine. Your starting dose will be small, and gradually increased until your prolactin levels normalise.

More information can be found on the websites for the NHS, Your Hormones and the Mayo Clinic.

Treatment for Prolactin Abnormality

Click here to view Diagnosing Prolactin Abnormality

Treatment for excess prolactin (hyperprolactinemia)

If your prolactin excess is caused by thyroid deficiency, your thyroid levels will be restored by thyroid replacement medicine and this will also cause your prolactin level to normalise.

If your regular medicine is the reason for your high prolactin levels, your doctor will try you on a different medicine or add one to help your prolactin levels go down.

Treatment for insufficient prolactin (hypoprolactinemia)

If you are having difficulty breastfeeding you may be treated with Metoclopramide. If you have fertility problems due to insufficient prolactin you may be treated with clomiphene citrate (50 mg/d for 5 days) or with gonadotropins (LH, FSH).

More information can be found on the websites for the NHS, Your Hormones and the Mayo Clinic.

Treatment for Growth Hormone Deficiency (GHD)

Injections

Side effects

Monitoring

Repeat questionnaire

Treatment for Cortisol Deficiency

Medication

Sick day rules

Adrenal crisis

Treatment for Sex Hormone Deficiency (Secondary Hypogonadism)

For males

Testosterone replacement

Effects

Monitoring

Side effects

Treatment for infertility

For females

Estrogen, progesterone, testosterone

Effects

For infertility

Treatment for Thyroid Hormone Deficiency (Hypothyroidism)

Note

Treatment for Arginine Vasopressin Deficiency (AVD) (Diabetes Insipidus)

Note

Treatment for Prolactin Abnormality

Treatment for excess prolactin (hyperprolactinemia)

Treatment for insufficient prolactin (hypoprolactinemia)

Helping you get diagnosed and treated for hypopituitarism

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