Treatment of patients after removal of pituitary
Endocrinology / / May 16, 2016
primary and vital task of therapy is to provide the patient a sufficient amount of glucocorticoid.This problem can be solved by systemic administration of ACTH.
However, this type of treatment is little advisable because of the necessity of daily injections, but mainly due to the possibility of ACTH insensitivity due to antibody production and down-adrenal response to ACTH.Therefore, the most appropriate is a glucocorticoid replacement therapy.As in patients with primary chronic insufficiency of the adrenal cortex, the most appropriate drug for substitution treatment is cortisone, having both glikokortikoidnym and some mineralocorticoid action.cortisone dose is usually 12,5-37,5 mg ingestion.Under conditions of stress (infection, trauma, or physical and t. P.) In glucocorticoid demand increases and cortisone dose should be increased to 100-200 mg per day.There may be a need for parenteral administration of glucocorticoid.Due to the fact that production of aldosterone in patients after the removal of th
With the development of symptoms of hypothyroidism patients shows the use thyroidin.Treatment should start with small doses - 0,015 thyroidin 1-2 times a day, gradually increasing the dose up to 0.05-0.1 per day.The transition to the next higher dose each thyroidin should be made at intervals of 7-10 days in patients with hypothyroidism.It should be understood that in patients after removal of the pituitary, thyroid, along with failure, and there is insufficiency of the adrenal cortex.Therefore, treatment should begin tireoidinom only therapy has selected doses of cortisone in the absence of symptoms of adrenocortical insufficiency and should be carried out with extreme caution so as not to cause adrenal insufficiency.
question of the application of sex hormones should be resolved in each patient individually.In women younger after the removal of the pituitary gland can cause periodic uterine bleeding, like menstruation, cyclic use of estrogen with or without progestin combinations.Treatment of estrogen contributes to maintaining trophism genitals, normalizes a number of metabolic processes, and has a certain psychological value.To enhance the anabolic processes and enhance libido along with small doses of estrogen treatment of androgen may be employed, for example, methyltestosterone, 5 mg 1-2 times daily.In older women the use of sex hormones may also be shown in connection with their anabolic effect.It can be used a combination of both androgens and estrogens in combined therapy of menopausal hormone neurosis.Even more appropriate treatment of such patients anabolic steroids (metilandrostendiol 25 mg 1-2 times a day or sublingually methandrostenolone 5-10 mg per day orally).
have androgens in men 20-30 mg methyltestosterone daily sublingual daily or 25 mg testosterone propionate intramuscularly twice a week, not only have an anabolic effect, but can restore sexual feeling and potency.
- pituitary dwarfism.The clinical picture
- chromophobe pituitary adenoma
- tumors of the anterior pituitary
- clinical picture of acromegaly
- Diagnosis and differential diagnosis of acromegaly
- treatment of acromegaly
- Diagnosis and differential diagnosis of gigantism
course and prognosis
course and prognosis depend on the underlying disease, about which made the removal of the pituitary gland.Properly conducted replacement therapy can provide satisfactory compensation to patients indefinite period.
Employability of patients with pituitary gland removed, regardless of the underlying disease, significantly reduced due to the difficulties encountered in the physical and mental strain.In the absence of other diseases that reduce the ability to work, patients after removal of pituitary life must be translated into group II of disability, in some cases, with a resolution of light physical or mental work without occupational hazards.