PITUITARY GLAND PREPARATIONS

The importance of the standard­ization of preparations of the posterior, or infundibular, lobe of the pituitary gland (the liquor hypophysis of the new United States Pharmacopeia, pituitary solution, pituitary extract, etc.) is exemplified by a recent publication of Roth.[304] As is well known, the active constituent or constituents of this gland have not been isolated, and there is no chemical method of determining the activity and therapeutic value of various preparations. There are, however, certain physiologic methods by which the activity of such preparations may be determined with a considerable degree of exactness. The last revision of the Pharmacopeia, recognizing that the best attested field of usefulness for such preparations is in obstetrics, adopted as a test their activity on the uterus of the guinea-pig; the details of the method adopted by the Pharmacopeia are those described by Roth.[305] Roth now reports on the activity of seven samples of commercial infundibular extracts, the products of five American manufacturing pharmacists. Four of these samples were found to be of Pharmacopeia strength; the other three were much weaker. Of the latter, one had but one tenth, another but one fifth and the third but one fourth of the required activity. Those preparations which had been accepted by the Council on Pharmacy and Chemistry for inclusion in New and Non-official Remedies corresponded to the Pharmacopeia requirements. Roth also compared the activity of these seven preparations on the blood pressure, another method by which it has been proposed to standardize infundibular extracts. The four preparations which were equally active on the uterus were found to be equally active on the blood pressure; the other three were much weaker. Roth points out, however, that the results of the two methods are not necessarily parallel; in one instance, for example, two samples caused equal rises of blood pressure, but one was twice as active as the other on the uterus. Hence it is evident that the blood pressure test is not a satisfactory method for determining the activity of a preparation on the uterus, and vice versa.

The subject of pituitary standard­ization, or perhaps it may be said the application of the present method is, however, in need of further study. Thus the statement has recently been made[306] that commercial preparations are on the market which have from three to five times the activity of the Pharmacopeia standard; this was not the case, however, with the preparations examined by Roth. It is probable that some have used for comparison a weaker standard than that proposed by the Pharmacopeia; this, of course, would lead to the conclusion that the commercial preparations were stronger than the Pharmacopeia standard. Roth suggests that the employment of standards of unequal activity by the various supply houses could easily be eliminated by having a central laboratory distribute material for use as a standard. It will be recalled that before the United States Public Health Service established and began the distribution of standards for diphtheria and tetanus antitoxins, the commercial preparations of these varied even more in activity than do those of the pituitary extracts at present.

It is unnecessary to emphasize the importance of this subject; this is sufficiently evident to those who have followed the recent clinical literature on the use of pituitary extracts in obstetrics. These preparations are used in times of emergency; a weak preparation is valueless, whereas overdosage, either from too strong a preparation or from too free use of a preparation of the official strength, is often followed by disaster to the mother or child or both. Roth cites a number of cases of ruptured uterus and other injuries resulting from their use.—(Editorial from The Journal A. M. A., May 5, 1917.)