6.5 Hypothalamic and pituitary hormones and anti-oestrogens
These preparations are specialist use only and if required should only be used on the recommendation of a consultant, following prior detailed investigation of the patient.
Clomifene citrate (50mg tablets) is an anti-oestrogen which is indicated in anovulatory infertility. Note CSM warning: should not normally be used for longer than 6 cycles.
Tamoxifen is used in the treatment of anovulatory infertility, for use in breast cancer see 184.108.40.206.
Anterioir pituitary hormones
Tetracosactide (250micrograms/mL injection) is used for testing adrenocortical function.
Chorionic gonadotrophin (human chorionic gonadotrophin; HGC), choriogonadotropin alfa, follitropin alpha and follitropin beta (recombinant human follicle stimulating hormone) and human menopausal gonadotrophins are mainly used in infertility treatment.
Somatropin is synthetic human growth hormone and is indicated for use in children for the treatment of short stature in HGH deficiency states, Turner syndrome [see NICE guidance No 42] and for the treatment of growth disturbance in short children born small for gestational age as per SMC No 240/06 (Genotropin®) and SMC No 260/06 (Norditropin SimpleXx®). Treatment should be initiated and monitored by a paediatrician with expertise in managing childhood growth disorders and growth hormone therapy. Treatment may be initiated in the community on the recommendation of a specialist, and subject to an individual care plan being agreed between the consultant and the GP.
Thyrotropin alpha injection (900micrograms/vial) is a recombinant form of thyrotropin (TSH) and is used prior to radioiodine imaging to detect thyroid remnants or thyroid cancer in post-thyroidectomy patients.
Gonadorelin injection (gonadotrophin-releasing hormone) is used for the assessment of pituitary function.
POSTERIOR PITUITARY HORMONES
Desmopressin (tablets, sublingual tablets, injection, nasal spray) is used in the diagnosis and treatment of diabetes insipidus and for nocturnal enuresis.
Desmopressin oral lyophilisate s/l tablets (DDAVP Melt®) is used for the treatment of vasopressin-sensitive cranial diabetes insipidus and in the treatment of post-hypophysectomy polyuria/polydipsia. In patients for whom desmopressin is an appropriate choice of therapy, it offers a sublingual formulation at an equivalent cost to a clinically equivalent dose in a solid oral dose formulation.
Terlipressin (injection) is indicated for the treatment of bleeding oesophageal varices.