Pituitary Innovation and Teaching

Other types of treatment

Medicines

A third treatment option (to surgery and radiation) is medicine. Medicine can be used to:

  1. block the tumour from making too much hormone and sometimes reduce the size of certain types of pituitary tumours (prolactinomas and acromegaly)

  2. replace normal amounts of a hormone that has been lost due to pressure from the tumour or as a result of the effects of surgery or radiation.

Here are some medicines that patients with pituitary tumours might use.  Ask your doctors and pharmacist for more information.

To treat prolactinoma

Cabergoline (or Dostinex®), Bromocriptine (or Parlodel®) and Quinagolide (Norprolac®) are three drugs that prevent the release of the prolactin hormone. They can be all that is needed to treat up to 90 per cent of all patients with prolactinomas. 

Bromocriptine (or Parlodel®) and Quinagolide (Norprolac®) are taken once or twice a day whereas cabergoline (or Dostinex®) is usually given one to three times a week.  All can have side effects, including nausea, dizziness and stuffy nose. These side effects happen less often with Cabergoline. 

Cabergoline is more expensive but all three are generally covered by most drug insurance plans. Bromocriptine is covered for patients on Trillium or Ontario Drug Benefits (ODB).

To treat acromegaly

Octreotide (or Sandostatin®) reduces the release of growth hormone in acromegaly and sometimes reduces the tumour size modestly. It is given as an injection every three or four weeks by a nurse. Most commonly, it is used in addition to surgery. In rare cases, it may be used alone when surgery is not possible. 

This drug can cause gallstones, abdominal cramps and diarrhea. It is very expensive and can be used before surgery or as a lifelong treatment. It is covered for patients on Trillium or Ontario Drug Benefits (ODB) and by most insurance companies.

Hormone replacement

As the master hormone gland, the pituitary produces 7 different hormones, which control other important hormone-producing glands. The hormones from these other glands may need to be replaced when levels are low:

Cortisol

Hydrocortisone (Cortef®) and prednisone are synthetic forms of the hormone cortisol. Either can be given to replace low amounts of the hormone in patients whose pituitary gland is not working properly. Too little hormone results in nausea, vomiting, dizziness, weakness and weight loss. Too much cortisol may cause symptoms similar to Cushing’s disease. 

Thyroid Hormone

Levo-thyroxine is the synthetic replacement for thyroid hormone. It comes in different strengths and preparations. It is taken with water first thing in the morning on an empty stomach. If you have low levels of thyroid hormone, you will feel tired, cold, constipated and may gain weight. Too much will make you feel anxious, with shaking hands and a racing heart beat.

Sex Hormones

Pre-menopausal women who stop having periods due to a loss of pituitary function will need estrogen and progesterone to protect their bone density. These hormones are often given in the form of the birth control pills, or as patches.

Men will need testosterone therapy to restore sex drive and sexual function if this hormone level is too low. They will get this therapy as an injection in a muscle every two weeks, or as gels, patches or pills.

For fertility, both men and women will need other injected medicine, to replace the missing pituitary hormones (LH and FSH) if they have low levels of the pituitary hormones that control the function of the testes or ovaries.

Antidiuretic Hormone (ADH)

ADH is a hormone that is made by the pituitary gland and causes the kidney to make concentrated urine. If the pituitary gland does not produce enough ADH, the body will make too much urine (over three litres a day) and the person becomes very thirsty.

DDAVP is a synthetic form of ADH. It is taken to increase the level of ADH in your body. DDAVP comes in different forms: as pills that are either melted under the tongue or swallowed, as a form that is sprayed into the nostril, or as an injection.

With more ADH in the body, the person will feel less thirsty and will not produce urine as frequently. The most common time for ADH to be low is right after surgery, but it usually comes back to normal levels after days to weeks.

Growth Hormone

Finally, growth hormone levels can be low. This causes children to stop growing until they    receive daily injections of growth hormone. Adults may feel very tired due to the lack of growth hormone, and may choose to take growth hormone therapy to improve their energy levels.  Growth hormone therapy is very expensive, but the cost may be covered by private insurance or Trillium/Ontario Drug Benefits.

 

Page last updated: June 21, 2017