Treatment of panhypopituitarism

Treatment of hypothalamic-pituitary insufficiency should be aimed at compensating for hormonal deficiency, and, where possible, to eliminate the cause of the disease. In clinical practice, mainly hormonal preparations of peripheral endocrine glands and to a lesser extent lacking tropic hormones of adenohypophysis (due to the lack or insufficiency and high cost of pure preparations of human hormones) are used. A significant obstacle to the use of drugs of the pituitary hormones is the rapid development of refractoriness to them in connection with an increase in the level of antibodies.

In a disease with primary destruction of the pituitary gland and fast-progressive emaciation (Simmonds' pituitary cachexia), therapy is almost unsuccessful. Significantly more effective timely treatment of postpartum hypopituitarism (Shien syndrome). Regardless of the nature of the disease with all forms of organic hypopituitarism, treatment should be persistent, systematic and carried out almost always throughout life.

A tumor or cyst that causes destruction in the pituitary or hypothalamus is subject to radical treatment (surgical, radial, administration of radioactive yttrium, cryodestruction).

The forms of the disease caused by acute or chronic infection are treated with special or anti-inflammatory drugs.

Hormone replacement therapy usually begins with drugs of the adrenal cortex, sexual and, lastly, thyroid. To eliminate hypokorticism, oral medications are used, but in severe cases, treatment is started with parenterally administered agents. Glucocorticoids are prescribed : hydrocortisone (50-200 mg daily), and when hypocorticoid symptoms decrease, they switch to prednisolone (5-15 mg) or cortisone (25-75 mg / day). Mineralocorticoid insufficiency is eliminated by 0.5% deoxycorticosterone acetate (DOXA) - 0.5-1 ml intramuscularly daily, every other day or 1-2 times a week, then switching to sublingual tablets 5 mg 1-2 times a day. A 2.5% suspension of deoxycorticosterone trimethyl acetate with a two-week extension is also used. In severe hypotension, subcutaneous implantation of a DOXA crystal containing 100 mg of a hormone is effective, with a duration of 4-6 months.

On the background of substitution therapy with corticosteroids (10-15 days from the beginning) ACTH (corticotropin) is added to a short or (better) prolonged (24-30 h) action. Treatment begins with small doses - 0,3-0,5 ml per day (7-10 ED), gradually increasing the dose to 20 units daily. For courses that repeat after 6-12 months, 400-1000 units. Greater efficacy and better tolerability are observed when using synthetic corticotropin with a shortened polypeptide chain - "synakten-depot" for parenteral administration (1 ml -100 ED - 1-3 times a week).

Insufficiency of the sexual glands is compensated in women with the help of estrogens and progestins, and in men - drugs of androgenic action. Treatment with sex hormones is combined with the administration of gonadotropins. Replacement therapy for women artificially recreates the menstrual cycle. For 15-20 days, estrogens are administered (eg, 0.05 mg per day of microfoline) and in the next 6 days - gestagens (pregnin - 10 mg 3 times daily or 1-2.5% progesterone 1 ml daily, 1 tablet 3 times a day). After preliminary treatment with sex hormones and reduction of atrophic processes in the genitals, gonadotropins are prescribed, it is also desirable to use follicle-stimulating menopausal gonadotropin for 300-400 ED every other day for the first 2 weeks, and 1000 to 1500 ED for the subsequent 2 weeks luteinizing (chorionic). To stimulate the gonadotropic function with partial or functional insufficiency, use clostilbegite 50-100 mg for 5-9 or 5-11 days of the cycle. Sometimes chorionic gonadotropin is added to estrogens on the 12th, 14th and 16th day of the cycle, i.e., during the period of supposed ovulation. In the case of Shiena syndrome with a long history of the disease, when it is no longer necessary to count on the stimulating effect of the administration of gonadotropins, synthetic combined progestin-estrogen drugs (infecondin, bisecurin, non-vellon, rigevidone, triziston) are used for the substitution. In addition to a specific effect on the reproductive apparatus, the corresponding hormones have a positive trophic and anabolic effect.

In men with a substitutional goal, methyltestosterone is administered 5 mg 3 times a day under the tongue, testosterone propionate 25 mg 2-3 times per week intramuscularly or prolonged-release preparations: 10% testane solution 1 ml every 10-15 days, sustanon -250 on 1 ml 1 time in 3-4 weeks. Substitution therapy with androgens at a young age alternates with the introduction of chorionic gonadotropin by 500-1500 units 2-3 times a week by repeated courses for 3-4 weeks. With oligospermia of varying degrees, clostilbegite 50-100 mg for 30 days is used.

Thyroid deficiency is eliminated by thyroid hormones administered concomitantly with corticosteroid preparations, since the intensification of metabolic processes aggravates hypocorticism. Treatment begins with thyroidin at 0,025-0,05 mg and triiodothyronine 3-5 μg daily with a very slow increase in the dose to 0.1-0.2 mg and 20-50 μg, respectively, under the control of heart rate and ECG. In recent years, predominantly synthetic combination preparations containing thyroxine and triiodothyronine (thyreocomb, thyrotome) have been used. Caution in the administration of thyroid medications is determined not only by hypocorticism, but also by the hypersensitivity of myocardium to hypothyroid patients and the need for gradual adaptation in this regard.

Treatment of hypopituitary coma includes large doses of parenteral corticosteroids, intravenous or subcutaneous injection of 5% glucose (500-1000 ml / day), vascular and cardiac agents.

Patients with panhypopituitarism need vitamins, anabolic hormones, a high-calorie, protein-rich diet. Targeted hormone therapy - by cycles or constantly - is carried out throughout life. The work ability of patients, as a rule, is reduced.