Advances in medical therapy for pituitary disease: treating patients with growth hormone excess and deficiency.

Two recent developments in the medical treatment of patients with pituitary disease are discussed. Conventional treatment for patients with acromegaly has been surgery and/or radiotherapy. Dopamine agonist therapy may be useful. Somatostatin is a naturally occurring neuropeptide that inhibits growth hormone (GH) secretion. The development of long-acting preparations has resulted in a considerable advance in the medical treatment of acromegaly, though some caution remains about the long-term side-effects of such therapy (e.g. cholelithiasis) and its cost/benefit analysis. Although further epidemiological studies are required, hypopituitarism appears to be associated with an increased mortality rate, and this has largely been attributed to GH deficiency. With the widespread availability of recombinant GH (thereby circumventing any risks from cadaveric GH) many adult GH-deficient patients are now being treated. Beneficial effects on body composition, nitrogen and calcium balance and bone mass have already emerged, although studies on 'well being' have been conflicting. The debate continues concerning the minimum effective dose and who exactly should be treated, in view of the costs incurred. The endocrinologists' use of long-acting somatostatin analogues and recombinant GH will undoubtedly increase over the next few years. Whilst it is clear that many patients with both acromegaly and hypopituitarism will benefit, long-term controlled trials are still required to establish firmly the benefit in terms of major morbidity.