Treatment of hypopituitarism

Abstract

A clinical trial in which four patients with post-partum pituitary insufficiency were treated for varying periods on combined treatment consisting of D.C.A., sodium chloride, testosterone, stilboestrol, thyroid, and cortisone, and on cortisone alone, is described. Three patients continued in good health on cortisone alone, while one patient relapsed and had to continue with thyroid. Cortisone alone was thought to be inferior to combined therapy in respect of minor changes in skin in two patients, regression of the electrocardiogram in two, and return of cold-intolerance in one. It appeared that these changes were related to the withdrawal of thyroid, as they quickly improved when this drug was restarted. From the study of these four patients and others treated since the trial ended, we regard cortisone and thyroid as the essential drugs to maintain good health in hypopituitarism. While cortisone alone seems to be little inferior to combined therapy, the effect of thyroid on the skin, electrocardiograms, and in some cases (which are apparently often unpredictable) intolerance to cold makes its routine use desirable. D.C.A. and salt therapy are unnecessary and complicate treatment, while testosterone is not advocated as routine therapy in female patients unless libido remains deficient without it. © 1957, British Medical Journal Publishing Group. All rights reserved.