Macroadenomas

(of pituitary)

§> 10 mm in size

Microadenomas

(of pituitary)

§< 10 mm in size

Hyperpituitarism

(most common cause)

linear growth:long bones

muscle cells; protein, carbohydrate, lipid, and mineral metabolism

--Postpartum Pituitary necrosis

--infarction of lactotrophs during birth

-->prolactin deficiency

Treat with metoclopramide

What medications can decrease prolactin producitons?

Dopamin agonists: bromocryptine (Parlodel) and Dostinex

Action: Typical anabolic and anticatabolic effects of GH; linear growth; long bones, muscle cells; protein, carbohydrate, lipid, and mineral metabolism

Contraindications: Malignancy, intracranial lesions, closed epiphysis

Precautions: Diabetes

Adverse Reactions: Serious include leukemia, pancreatitis, intracranial hypertension.  Less serious include injection site pain and lipodystrophy, HA, hyperglycemia & glucosuria, mole growth, gynecomastia, carpal tunnel

Action: Inhibits hormones such as GH, insulin, LH, VIP

Indications: GH excess, diarrhea from VIPoma, secretory diarrhea associated with carcinoid tumors, bleeding esophageal varicies

Precautions: DM, cardiovascular disease, hepatic disease

Adverse Reactions: *hypothyroidism, flu-like syndrome; more serious include HTN, arrhythmias, gallbladder and pancreas problems

--treatment of ACROMEGALY

Bromocriptine

Action: Dopamine agonist; inhibits anterior pituitary prolactin secretion

Indications: Prolactinoma/prolactinemia, Parkinsonism, neuroleptic malignant syndrome

Precautons: HTN, hepatic or renal impairment, psychosis

Adverse reactions: Fatigue, orthostatic hypotension, LFT elevation; more serious include severe HTN, stroke, MI, seizures and frank psychosis

**treat ACROMEGALY and PROLACTINOMA (high prolactin)

Action: Binds to estrogen receptors, but anti-estrogen effects as well

Other Indication: May stimulate male pituitary and increase testosterone and sperm production

Contraindications: Pregnancy, ovarian cysts, pituitary tumor, CA

Adverse Reactions: multiple pregnancies (triplets, quadruplets and quintuplets increase X10), emboli, hot flashes, premenstrual/menstrual complaints

Pregnancy: Category X

**sex hormone replacement in females**

Action: Increases milk yield in lactating women.  GI pro-kinetic agent is its most common use.

Precautions: GI obstruction, hemorrhage, or perforation; pheochromocytoma, Parkinsonism, seizure.

Adverse Reactions: GI pain, extrapyramidal reactions, lowered seizure threshold.

--not a prolactin anolog jsut ncreases milk produciton

**Used in prolactin deficiency such as Sheehan syndrome**

 Action: Dopamine D2 agonist

Precautions: Pregnancy, hepatic impairment.

Adverse Reactions: More commonly constipation, insomnia, vertigo, orthostatic hypotension.  Severe side effects and intolerance are less common than with bromocriptine.

**used in prolactinoma to decrease prolactin secretion**

Action: Acts same as ADH.

Precautions: CAD, HTN, Hepatic disease or elevated liver functions.

Adverse Reactions: hyponatremia and water intoxication are possible and more serious; headache, dizziness, nausea, abdominal pain, cough, flushing.

**Treatment of Diabetes Insipidus**

ADH

treatment of Diabetes Insipidus

**short half life and degraded by vasopresinase**

Action: Exact mechanism is unknown

Contraindications: OB related

Adverse Reactions: Gyn related

**induction of labor, and milk letdown**

--Conginital Hypogonadism

  -hypogonadotropic hypogonadism

  -puberty delayed

  -males with crytorchidism and micropenis

  -females with primary amenorrhea

**treat with HCG**