Skip to main content
SpringerLink
Log in

Medikamentöse Therapie von Hypophysenerkrankungen

Pharmacotherapy of pituitary diseases

  • Arzneimitteltherapie
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Eine erfolgreiche medikamentöse Pharmakotherapie von hypophysären Hormonexzessen ist lediglich für die Behandlung der Akromegalie (Dopaminagonisten, Somatostatinanaloga und Wachstumshormonrezeptorantagonisten) und des Prolaktinoms (Dopaminagonisten) etabliert. Allerdings ist bei der Akromegalie die transsphenoidale Hypophysenoperation die Therapie der ersten Wahl, während beim Prolaktinom nur in Ausnahmefällen eine Operationsindikation besteht.

Bei einer endokrinen Insuffizienz der Hypophyse ermöglicht eine Substitutionstherapie dem Patienten eine normale Belastbarkeit und Lebensqualität. Die Substitution der kortikotropen und thyreotropen Achse mit Hydrocortison und L-Thyroxin ist lebensnotwendig. Die gonadotrope Achse sollte bei der Frau zumindest bis zum Zeitpunkt des natürlichen Klimakteriums mittels Östrogen/Gestagenpräparaten ersetzt werden. Beim Mann sollte, solange keine Kontraindikationen bestehen, die Substitutionstherapie lebenslang erfolgen (transdermales Testosteronpflaster, Testosterongele und Testosteronundecanoat bzw. -enantat). Bei Kinderwunsch bestehen bzgl. der Fertilität sehr gute Aussichten mit einer Gonadotropinbehandlung bzw. pulsatilen GnRH-Therapie. Insbesondere bei jüngeren Patienten scheint auch eine Wachstumshormonsubstitution (Somatropin) sinnvoll.

Abstract

Successful pharmacotherapy of pituitary hormonal excess is established only in the treatment of acromegaly (dopamine agonists, somatostatin analogues, GH-receptor-antagonists) and of prolactinomas (dopamine agonists). Gold standard in the treatment of acromegaly is transsphenoidal pituitary surgery, while in prolactinomas, surgery is indicated only in exceptional cases. Substitution of pituitary insufficiency offers the patients a normal quality of life. Substitution of the cortico- and thyreotrope axis with hydrocortisone and levothyroxine is vital. In women, substitution of the gonadotrope axis should be performed up to menopause (estrogen/gestagen). In men, substitution should be performed lifelong (trans-dermal testosterone body patches, testosterone gel, testosterone undecanoate/enanthate). To achieve fertility, gonadotropins or pulsatile GnRH therapy has verry good results. Especially in younger patients, substitution of growth hormone may be useful (somatropin).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Abs R, Verhelst J, Maiter D et al. (1998) Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab 83: 374–378

    Article  PubMed  Google Scholar 

  2. Arlt W, Callies F, van Vlijmen JC et al. (1999) Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 341: 1013–1020

    Article  PubMed  Google Scholar 

  3. Arver S, Dobs AS, Meikle AW, Allen RP, Sanders SW, Mazer NA (1996) Improvement of sexual function in testosterone deficient men treated for 1 year with a permeation enhanced testosterone transdermal system. J Urol 155: 1604–1608

    Article  PubMed  Google Scholar 

  4. Colao A, Di Sarno A, Cappabianca P, Di Somma C, Pivonello R, Lombardi G (2003) Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349: 2023–2033.

    Article  PubMed  Google Scholar 

  5. Cozzi R, Attanasio R, Montini M et al. (2003) Four-year treatment with octreotide-long-acting repeatable in 110 acromegalic patients: predictive value of short-term results? J Clin Endocrinol Metab 88: 3090–3098

    Article  PubMed  Google Scholar 

  6. Feenstra J, de Herder WW, ten Have SM et al. (2005) Combined therapy with somatostatin analogues and weekly pegvisomant in active acromegaly. Lancet 365: 1644–1646

    Article  PubMed  Google Scholar 

  7. Gutt B, Oltmann F, Bidlingmaier M, Dieterle C, Schopohl J (2004) Effects of long acting somatostatin analogues on glucose tolerance and insulin resistance in acromegaly. 11th meeting ENEA, abstract P4.74

  8. Gutt B, Bidlingmaier M, Kretschmar K, Dieterle C, Steffin B, Schopohl J (2005) Four-year follow-up of acromegalic patients treated with the new long-acting formulation of Lanreotide (Lanreotide Autogel). Exp Clin Endocrinol Diabetes 113: 139–144.

    Article  PubMed  Google Scholar 

  9. Kohler B, Piecha K, Reichardt B, Schopohl J, von Werder K (1996) Longterm treatment of macroprolactinoma patients — a retrospective analysis of patients treated from 1971 to 1994. In: von Werder K, Fahlbusch R (eds) Pituitary adenomas: From basic research to diagnosis and therapy. Elsevier, pp 325–329

  10. Konopka P, Raymond JP, Merceron RE, Seneze J (1983) Continuous administration of bromocriptine in the prevention of neurological complications in pregnant women with prolactinomas. Am J Obstet Gynecol 146: 935–938

    PubMed  Google Scholar 

  11. Kraan GP, Dullaart RP, Pratt JJ (1998) The daily cortisol production reinvestigated in healthy men. The serum and urinary cortisol production rates are not significantly different. J Clin Endocrinol Metab 83: 1247–1252

    Article  PubMed  Google Scholar 

  12. Krupp P, Monka C (1987) Bromocriptine in pregnancy: safety aspects. Klin Wochenschr 65: 823–827

    Article  PubMed  Google Scholar 

  13. Molitch ME (1999) Diagnosis and treatment of prolactinomas. Adv Intern Med 44: 117–153

    PubMed  Google Scholar 

  14. Nomikos P, Buchfelder M, Fahlbusch R (2005) The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‚cure’. Eur J Endocrinol 152: 379–387

    Article  PubMed  Google Scholar 

  15. Rosen T, Bengtsson BA (1990) Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 336: 285–288

    PubMed  Google Scholar 

  16. Trainer PJ, Drake WM, Katznelson L et al. (2000) Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med 342: 1171–1177

    Article  PubMed  Google Scholar 

  17. van der Lely AJ, Hutson RK, Trainer PJ et al. (2001) Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 358: 1754–1759

    Article  PubMed  Google Scholar 

  18. van der Lely AJ, Muller A, Janssen JA, Davis RJ, Zib KA, Scarlett JA, Lamberts SW (2001) Control of tumor size and disease activity during cotreatment with octreotide and the growth hormone receptor antagonist pegvisomant in an acromegalic patient. J Clin Endocrinol Metab 86: 478–481

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. 3. Med. Abteilung, Endokrinologie, Diabetologie und Angiologie, Städtisches Klinikum München-GmbH, Krankenhaus Bogenhausen

    B. Gutt

  2. Medizinische Klinik Innenstadt, Klinikum der Universität München

    B. Steffin & J. Schopohl

  3. 3. Med. Abteilung, Endokrinologie, Diabetologie und Angiologie, Städtisches Klinikum München-GmbH, Krankenhaus Bogenhausen, Englschalkinger Str. 77, 81925, München

    B. Gutt

Authors
  1. B. Gutt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Steffin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Schopohl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Gutt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gutt, B., Steffin, B. & Schopohl, J. Medikamentöse Therapie von Hypophysenerkrankungen. Internist 46, 1158–1165 (2005). https://doi.org/10.1007/s00108-005-1482-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-005-1482-x

Schlüsselwörter

Keywords

Search

Navigation