mone. Hormonal drug therapy is used for hormones produced by the pituitary,
thyroid, parathyroid, and adrenal glands.
DRUGS AND THE PITUITARY GLAND
Growth hormone (GH) is secreted by the pituitary gland to influence growth.
Gigantism (during childhood) and acromegaly (after puberty) can occur with
GH hypersecretion. They are frequently caused by a pituitary tumor. If the tumor
cannot be destroyed by radiation, or bromocriptine, a prolactin-release inhibitor
can inhibit the release of GH from the pituitary. Octreotide (Sandostatin) is a
potent synthetic somatostatin used to suppress growth hormone release. It is
very expensive and gastrointestinal side effects are common.
If the pituitary gland produces too little GH, the patient will not reach a normal
height. This is referred to as GH deficiency. Patients with this deficiency undergo
GH replacement using Somatrem (protropin) and somatropin (Humatrope) to
replenish the missing GH and enable normal growth to occur.
The posterior pituitary gland secretes antidiuretic hormone (ADH) and oxy-
tocin. ADH is a vasopressin. Oxytocin is released to start labor contractions.
ADH promotes water reabsorption from the renal tubules to maintain water
balance in the body’s fluids. A deficiency of ADH, called diabetes insipidus
(DI), causes the kidneys to excrete large amounts of water. This leads to severe
fluid volume deficit and electrolyte imbalances.
Diabetes insipidus can also be caused by head injury and brain tumors result-
ing in trauma to the hypothalamus and pituitary gland. You must monitor fluid
and electrolyte balance in patients who have diabetes insipidus. ADH replace-
ment may be needed.
Some of the drugs used for pituitary disorders include desmopressin acetate
(DDAV), desmopressin (Stimate), lypressin (Diapid), vasopressin (aqueous)
(Pitressin), vasopressin tannate/oil (Pitressin Tannate).
A list of anterior pituitary hormone and posterior pituitary hormone drugs are
provided in the Appendix. Detailed tables show doses, recommendations, expec-
tations, side effects, contraindications, and more; available on the book’s Web
site (see URL in Appendix).
DRUGS AND THE ADRENAL GLAND
There are two adrenal glands—located near the top of each kidney. The adrenal
gland is comprised of two parts: the adrenal medulla and the adrenal cortex.
CHAPTER 21 Endocrine Medications^387