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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the mediators and primary effects of pituitary hormones.

  2. Identify clinical features of patients with acromegaly.

  3. Discuss the role of surgery and radiation therapy for patients with acromegaly.

  4. Select appropriate pharmacotherapy for patients with acromegaly based on patient-specific factors.

  5. Identify clinical features of children and adults with growth hormone (GH) deficiency and select appropriate pharmacotherapy for these patients.

  6. Recommend monitoring parameters necessary to assess therapeutic outcomes and adverse effects in patients receiving GH therapy.

  7. List common etiologies of hyperprolactinemia.

  8. Identify clinical features of patients with hyperprolactinemia.

  9. Select appropriate pharmacologic and nonpharmacologic treatments for patients with hyperprolactinemia based on patient-specific factors.

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KEY CONCEPTS

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  • Image not available. Surgical resection of the pituitary tumor through transsphenoidal pituitary microsurgery is the treatment of choice for most patients with growth hormone (GH)–producing pituitary adenomas.

  • Image not available. Somatostatin analogs are the mainstay of pharmacotherapy for the treatment of acromegaly when surgery is contraindicated or has failed, or as an adjuvant therapy until radiation effect is sustained.

  • Image not available. Pegvisomant, as monotherapy or adjuvant therapy to somatostatin analogs, is indicated for patients who do not tolerate or have an inadequate response to other treatment options.

  • Image not available. Dopamine agonists may be appropriate for patients with markedly elevated insulin-like growth factor-I (IGF-I) levels who have GH and prolactin cosecreting tumors, or as an additive therapy to somatostatin analog in patients with partial response to somatostatin.

  • Image not available. Prolonged exposure to elevated GH and IGF-I levels can lead to serious complications in patients with acromegaly. Comorbid conditions such as hypertension, diabetes, dysrhythmias, coronary artery disease, and heart failure should be aggressively managed to prevent vascular and neuropathic complications.

  • Image not available. Recombinant GH therapy is the main pharmacologic treatment for GH deficiency in both children and adults.

  • Image not available. Although comparative trials have not been conducted, recombinant GH products appear to have similar efficacy for treating GH deficiency as long as the regimen follows currently approved guidelines.

  • Image not available. Dopamine agonists are the first-line treatment of choice for all patients with symptomatic hyperprolactinemia; transsphenoidal surgery and radiation therapy are reserved for patients who are resistant to or severely intolerant of pharmacologic therapy.

  • Image not available. Women who become pregnant while taking a dopamine agonist should discontinue treatment immediately to minimize fetal exposure. Because cabergoline has a long half-life, women who plan to become pregnant should discontinue the drug at least 1 month before planned conception.

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PHYSIOLOGY OF THE PITUITARY GLAND

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The pituitary gland, located at the base of the brain in proximity to the nasal cavity, is a small endocrine gland about the size of a pea weighing approximately 600 mg. The pituitary gland is referred to as the "master gland" because it is responsible for the regulation of many other endocrine glands and body systems. Growth, development, metabolism, reproduction, and stress homeostasis are among the functions influenced by the pituitary. Functionally, the gland consists of two distinct sections: the anterior pituitary lobe (adenohypophysis) ...

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