Pituitary hormones: Uses, common brands, and safety info

Pituitary hormones are vital to the proper function of the body. Sometimes, medications are needed to replace these hormones or augment their production. Keep reading to learn more about how these medications mimic different types of pituitary hormones, what they are used for, and some side effects associated with their use. 

What are pituitary hormones?

The pituitary gland (hypophysis) is a small, bean-sized gland cradled in the base of the brain called the sella turcica, which sits in the sphenoid bone in the skull. The pituitary gland consists of two lobes called the anterior pituitary (comprised of glandular tissue) and the posterior pituitary (comprised of neural tissue). There is an intermediate zone in between the lobes that secretes melanocyte-stimulating hormone, the hormone responsible for melanin formation in melanocytes.  

Known as the “master gland” of the body, the primary job of the pituitary gland is to secrete a lot of hormones. When pituitary hormone production is inadequate or inappropriate, medications made to stimulate or turn off hormone production may be used. These medications are usually extremely effective with very tolerable side effect profiles.  

How do pituitary hormones work?

The hypothalamus and the pituitary work together to control much of the endocrine function in the body. Both endocrine glands secrete hormones that regulate the synthesis and secretion of hormones in other glands and coordinate messages of the endocrine system and nervous system. 

There are several ways pituitary hormone replacement can act. First, the replacement hormones can stimulate the same tissues and end organs in the same way the native hormone would. These are called agonists. Alternatively, replacement hormones can inhibit hormones and tissues. These are called antagonists. How these hormones are used in the practice of endocrinology will depend on the condition they are being used to treat.   

Types of pituitary hormones

There are eight hormones released from the pituitary gland; each hormone has a specific mechanism of action and acts on specific target tissues of the body. These hormones are:

• Anterior pituitary 

  • Growth hormone (GH)

  • Prolactin (PRL)

  • Thyroid-stimulating hormone (TSH)

  • Adrenocorticotropic hormone (ACTH) 

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH) 

• Posterior pituitary 

  • Antidiuretic hormone (ADH) also called vasopressin 

  • Oxytocin  

Most pituitary hormones have isolated or synthesized versions that are used clinically. The exception to this is prolactin, as the clinical manifestations from aberrations in prolactin are usually the result of pituitary tumors, an underactive thyroid gland (hypothyroidism), or stress-induced damage to the anterior pituitary gland.  

Growth hormone agonists  

Growth hormone agonists are used to replace growth hormone in conditions where it is deficient, growth in childhood is clinically inadequate, or metabolic wasting has occurred. These conditions include:

• Growth hormone deficiency

• Idiopathic short stature (clinically short stature where the cause is unknown) 

• HIV-associated cachexia (progressive weight loss and wasting from advanced HIV/AIDS)

• Growth failure from chronic kidney disease (CKD)

• SHOX-associated short stature (a genetic condition that results in short stature)

• SGA-associated short stature (stature is small for a baby’s gestational age)

• Turner-associated short stature (a genetic condition with growth failure in genetic females)

• Prader-Willi-associated growth failure (a genetic condition with associated low levels of GH)

As part of the management for all of these conditions, recombinant human growth hormone (somatropin) is used as an injection. Somatropin is manufactured under these brand names: 

• Nutropin

• Nutropin AQ

• Saizen

• Serostim

• Zomacton

• Omnitrope

• Genotropin

• Humatrope

• Norditropin

Growth hormone antagonists 

Growth hormone antagonists (GHA) are used in adults and children to suppress the amounts of prolactin and growth hormone released from the anterior lobe. Prolactin is one of the most important hormones responsible for breast milk production during breastfeeding. GHAs are typically used in conditions where there is inappropriate prolactin production or when it would be helpful to decrease the release of growth hormone. There are other brand-specific uses listed below.   

Cycloset, Parlodel (bromocriptine), and cabergoline 

Bromocriptine promotes the release of dopamine (DA) from the hypothalamus. Dopamine release tells the anterior pituitary to stop producing prolactin and to reduce the production of growth hormone. Bromocriptine is used in the following conditions:

• Hyperprolactinemia

• Prolactin-secreting adenoma

• Acromegaly (gigantism)

• Parkinson’s disease

• Type 2 diabetes mellitus 

Somatuline Depot (lanreotide) and Sandostatin/Sandostatin LAR (octreotide) 

Lanreotide and octreotide are synthetic versions of the peptide hormone somatostatin. Somatostatin is produced by the hypothalamus, pancreas, and gastrointestinal tract. It exhibits inhibitory effects across multiple systems, modifies neurotransmitters, and has an antiproliferative effect on cells. It is typically used in the treatment of neuroendocrine tumors and the conditions listed below, with specific indications depending on the formulation.   

• Acromegaly

• Pituitary adenoma 

• Neuroendocrine tumors

  • Insulinoma

  • GRFoma

  • Glucagonoma

  • Pheochromocytoma

  • Somatostatinoma

  • Carcinoid

  • VIPoma

  • Gastrinoma 

Luteinizing hormone agonists 

Human chorionic gonadotropin (HCG) is a polypeptide hormone produced by the placenta. HCG has two subunits, alpha and beta. The alpha subunit is almost identical to the alpha subunits of LH, FSH, and TSH. Chorionic gonadotropin preparations are available under the brand names Novarel, Ovidrel, and Pregnyl, and are used clinically in the management of conditions below related to the male and female gonads (testes and ovaries).    

• Prepubertal cryptorchidism (condition where the testes do not migrate into the scrotal sac)

• Hypogonadism (failure of the gonads to function properly) in males

• Induction of ovulation and pregnancy in an anovulatory, infertile woman  

Luteinizing hormone/follicle stimulating hormone replacement

Menopur (menotropins) is a combination of FSH and LH. Preparations are typically administered as a daily injection. Menotropins are used in assisted reproductive technology (ART) as “fertility hormones” to stimulate the maturation of multiple follicles within the ovaries and induce ovulation in women and sperm production in men. They are sometimes used with urofollitropin, depending on the specific ovulatory needs and institution specific protocols. 

Follicle stimulating hormone replacement 

Bravelle (urofollitropin) is a purified form of human FSH. When FSH is released, it stimulates the production and maturation of gametes (eggs and sperm) in the ovaries and testes. Bravelle is typically used in conditions of infertility to aid in reproduction by these mechanisms: 

• Induction of ovulation in women

• Development of multiple follicles in women as part of an ART cycle 

• Improvement of sperm quality and quantity in men 

Adrenocorticotropic hormone agonists

Acthar (corticotropin) and Cortrosyn (cosyntropin) are both synthetic versions of adrenocorticotropic hormone. ACTH is released from the anterior pituitary where its primary target is the release of cortisol from the adrenal glands. Cortisol release in appropriate amounts has many essential metabolic functions. However, too much cortisol over a prolonged period of time is known as Cushing’s syndrome. This condition usually occurs as a result of pituitary tumors (Cushing’s disease), adrenal tumors, or exogenous steroid use. Cortrosyn is typically used in the diagnosis of this condition and can identify when adrenal insufficiency is the cause. 

Acthar is used in the following corticotropin-responsive conditions: 

• Infantile spasms

• Multiple sclerosis 

• Rheumatic conditions

• Collagen diseases 

• Erythema multiforme

• Stevens-Johnson syndrome 

• Serum sickness

• Inflammatory conditions of the eye

• Sarcoidosis

• Edema with proteinuria 

Thyroid stimulating hormone

Thyrogen (thyrotropin alpha) is a purified form of human TSH. Normally, TSH release signals the binding and uptake of iodine into the thyroid tissue and the synthesis and release of thyroid hormones from the thyroid gland. Thyrogen does not treat conditions of the thyroid gland, but it is used as a diagnostic and therapeutic adjunct for thyroid cancer. When individuals with thyroid cancer are given Thyrogen with radioactive iodine (which can be seen on imaging tests), there is an increase in thyroid uptake of radioiodine. This visible uptake is used to help medical specialists scan for thyroid cancer cells or target them to be killed.    

Vasopressin agonists 

DDAVP (desmopressin) is a synthetic form of antidiuretic hormone (vasopressin). ADH has several important roles in homeostasis, including regulating osmotic balance, blood pressure, and saltwater balance. In response to blood osmolarity and fluid volume status, ADH is released from the posterior lobe of the pituitary, where it affects the ability of the kidneys to reabsorb water. ADH also acts on vascular smooth muscle, causing contraction. These actions work together to improve blood pressure and conserve water in times of dehydration or fluid loss. ADH can also exert homeostatic effects by promoting the release of von Willebrand factor, a clotting factor that helps with bleeding. Inappropriate release or response to ADH can result in several disease states requiring administration of DDAVP, such as:    

• Diabetes insipidus 

• Nocturia (frequent nighttime urination)

• Nocturnal incontinence (bedwetting)  

• Hemophilia A

• Von Willebrand disease 

• Uremic bleeding 

• Renal concentration capacity test

Vasopressin antagonists 

Vasopressin antagonists are used to oppose the action of vasopressin and are typically only used when low serum sodium (hyponatremia) requires correction. By blocking the activity of vasopressin, Vaprisol (conivaptan) and Samsca (tolvaptan) cause the production and elimination of very watery urine, allowing salt to stay in the blood and increase serum sodium levels. Jynarque is another brand name of tolvaptan with restricted use in the management of autosomal dominant polycystic kidney disease (ADPKD).  

Oxytocin agonists 

Pitocin (oxytocin) is one of the most common medications administered during the peripartum state to strengthen uterine contractions, promote labor, and decrease bleeding after labor and delivery. Oxytocin also plays a role in milk release during breastfeeding, but medical Pitocin is not used for this purpose. 

Who can take pituitary hormones?

Can men take pituitary hormones?

Men can take the classes of pituitary hormones that are suitable for conditions that affect men. As men do not have a uterus, there is limited use for Pitocin in the male population.  

Can women take pituitary hormones?

Women can take all classes of pituitary hormones as indicated for their specific condition. 

Can you take pituitary hormones while pregnant or breastfeeding?

Some pituitary hormones are typically only used when a woman is pregnant, such as Pitocin. Medications that act on the gonads should not be taken while pregnant or breastfeeding. Other pituitary hormones should be avoided or used with extreme caution only if needed and if the benefit to the mother outweighs the risk to the fetus. 

Can children take pituitary hormones?

Children can take the classes of pituitary hormones that are indicated in conditions that affect growth or pubertal development. Children should not take hormones or dosages of hormones that are indicated for adults.  

Can seniors take pituitary hormones?

Seniors can take pituitary hormones that are indicated for conditions that may affect seniors. 

Are pituitary hormones safe?

Pituitary hormones are considered very safe classes of medications as most of them are either purified isolates of human hormones or peptide mimics. 

Restrictions:

• Hormones that act on the gonads or gonadotropins should not be taken while pregnant or breastfeeding. 

• Certain classes of gonadotropins are not indicated for use in children. These include chorionic gonadotropin alpha, menotropins, and urofollitropin. Tolvaptan is also not indicated for pediatric use.  

• Vasopressin agonists and antagonists should not be used in individuals with advanced kidney disease. 

Are pituitary hormones controlled substances?

Pituitary hormones are not controlled substances, however some have very restricted usages. 

Common pituitary hormones side effects

Each class of pituitary hormone has its own, very unique side effect profile. Typical side effects for each class of medication can be found on the package insert, manufacturer’s website, or the FDA website.  

How much do pituitary hormones cost?

Cost of these medications varies widely depending on the method of drug manufacturing.  Isolates of human hormones are very expensive to isolate and purify. Treatment with these medications is typically in the hundreds to thousands of dollars. Some medications that have been used for a long time and can be compounded more traditionally, such as bromocriptine, cabergoline, or DDAVP, cost a fraction of that at under $100 or under $50.