Hormone deficiency is treated by replacing the deficient hormones. The goals of treatment are to improve symptoms (see Table 2) and to replace the deficient hormone or hormones at a level that is as close to physiologically correct (mother nature) as possible. However, one rule of hormone replacement is that no one dose will suit every patient. Thus, when hormone replacement therapy is prescribed, the patient will need to be seen regularly after starting treatment to assess the effect. It often takes time and repeated dose changes to find the optimal dose for each patient. Typically, once the optimal dose is determined, the dose remains adequate for long-term treatment unless other medications are added or the patients condition changes in a way that alters the blood levels (e.g., introduction of GH therapy may require an increase in cortisol replacement, whereas pregnancy may require an increase in the dose of thyroid hormone).

Cortisol: On average, cortisol replacement therapy consists of giving approximately 15 mg of cortisol daily in divided doses. Approximately 2/3 of the dose is given in the morning and 1/3 in the late afternoon or evening. Excess cortisol can cause side effects (see the section on risks below), so it is best to use cortisol replacement in doses that are adequate but not too high.

Some endocrinologists prescribe prednisone instead of cortisol, and the dose of prednisone can be given once or twice a day. Patients with cortisol deficiency must always remember that during periods of stress their bodies may not be able to produce the increased level of cortisol needed. Therefore, patients should always carry a medical or steroid alert card or wear a medical alert bracelet or necklace to inform physicians that they are taking chronic steroid therapy. If patients have multiple pituitary hormone deficiencies, cortisol should always be the first hormone replaced as medications like thyroid hormone or GH can increase the bodys need for cortisol.

Thyroid hormone:Levothyroxine given daily is the therapy for thyroid hormone deficiency.

Sex-related hormones:Women: Premenopausal women who have no menstrual cycles as a result of pituitary disease (secondary hypogonadism) should receive replacement therapy with estrogen and progesterone. Estrogen can be given orally, by patch or by gel. Progesterone equivalent is only required in woman who have an intact uterus. Women who have undergone a hysterectomy can be treated with estrogen alone.

Men: In testosterone-deficient men, testosterone is given by patch, gel or injection either daily (patch or gel) or every 2-4 weeks by intramuscular injection.

GH therapy:GH prescribing practices vary depending upon local customs, national guidelines and insurance coverage. It is important to do tests to prove that patients are indeed GH deficient. Human GH is administered by daily injection. Most pituitary endocrinologists start at relatively low doses to avoid side effects and increase as needed.

DI therapy:Desmopressin is usually given in tablet or spray form (nasal tube or nasal spray). Hospitalized patients may be given desmopressin by injection.

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How Hypopituitarism is Treated | Learn More About ...

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