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Pharmacotherapy is available only for pituitary adenomas producing growth hormone and prolactin (acromegaly, hyperprolactinemia). While dopamine agonists and somatostatin analogues are usually administered to acromegaly patients only after unsuccessful surgery, dopamine agonists are the treatment of choice in patients with prolactinomas. Replacement treatment in patients with insufficiency of the anterior lobe of the hypophysis is oriented to the extent of the deficits. Theoretically, replacement treatment can be applied for any functional loss. Of essential importance is the replacement of lost adrenal cortical function by the regular administration of physiological doses of hydrocortisone, and of lost thyroid function by the administration of L-thyroxine. In high-stress situations, for example, due to severe illness, the hydrocortisone dose must be increased significantly, and if necessary given parenterally. Gonadal function is replaced either with gonadal steroid hormones or gonadotropin or GnRH in patients wishing to have children. In adults, replacement of growth hormone is also indicated to decrease cardiovascular risk. This, however is very expensive and requires s.c. injections.

The treatment of psoriasis and psoriatic arthritis by cyclosporin A, a new immunosuppressive agent believed to have a largely selective action on T lymphocytes, is described. Results in 4 cases show that cyclosporin A can bring about a most impressive improvement in psoriatic lesions of the skin and its appendages, but that its effect on the arthropathy is variable. There is still little certainty about the compound's mechanism of action in these conditions. Cyclosporin A may give rise to a whole range of side effects and its use--like that of other immunosuppressants--should therefore be contemplated only in severe and progressive forms of psoriasis and psoriatic arthritis resistant to other forms of treatment except cytostatic drugs.

The treatment of rheumatoid arthritis and psoriatic arthritis with cyclosporin A is described. Cyslosporin A is a new selective immunosuppressant which acts primarily on the T lymphocytes. It has already been shown to be effective in preventing rejection following kidney transplantation as well as in preventing graft-versus-host disease. In rheumatoid and psoriatic arthritis, however, its effect was not satisfactory, although rather different in the two conditions; overall only about one third of the patients showed any marked improvement. By contrast, and for reasons which are as yet unexplained, it had a beneficial effect on the cutaneous symptoms of psoriasis. Cyclosporin A had little effect on immune parameters. Side effects--mainly kidney toxicity, gastro-intestinal reactions and hirsutism--were common but reversible. On present evidence its principal indication among rheumatological diseases would seem to be as a treatment for severe, intractable psoriatic arthritis.

The new immunosuppressive substances Cyclosporin A (group A = 15 mg) and Cytimun = ASTA 5122 (group B = 15 mg, group C = 5 mg) were tested in rats that received accessory cervical heart transplants. A syngeneic (DA leads to DA) and a strongly allogeneic (PVG leads to DA) strain combination served as controls of operative and immunogenetic parameters. Whereas Cyclosporin A (group A) brought about a local transplant tolerance in 90% of cases, at a dosage of 15 mg/kg per day (group B), Cytimun led in 88% of cases to lethal intoxication of the recipients. At a dosage of 5 mg/kg per day (group C), 67% of the animals survived; however, they showed electrocardiographic evidence of possible temporary rejection crises between the 5th and the 13th day.