3. DEFINITIONS AND BACKGROUND
■ Hypopituitarism is an underactive pituitary gland.
■ A deficiency in production of pituitary hormones may be caused by tumor, trauma,
radiation to the brain, stroke or aneurysm, or surgery.
■ In hypopituitarism, there is a lack of one or more of these hormones and loss of function
in the affected gland or organ.
■ It may take years for an accurate diagnosis to be made.
■ If all pituitary hormones are missing, this is panhypopituitarism; it is relatively rare.
4. DEFINITIONS AND BACKGROUND
■ Adrenocorticotropic hormone (ACTH) stimulates the adrenal gland to release cortisol to
maintain BP and blood glucose levels.
■ If ACTH is missing, depression, fatigue, low BP, nausea and diarrhea, dizziness, pale
skin, weakness, and weight loss are signs and symptoms.
■ A shortage of cortisol can be life threatening.
■ Arginine vasopression (AVP) was formerly known as antidiuretic hormone (ADH).
■ AVP controls water loss by the kidneys.
■ If AVP is deficient, severe thirst and excessive urination occur; diabetes insipidus may
result.
■ In rare instances, deficiency may occur after an event such as brain surgery.
5.
6. ■ Growth hormone (GH) regulates somatic growth, carbohydrate and lipid metabolism, and
adipocyte functions.
■ There is a complex interplay between GH and insulin signaling (Perrini et al, 2008). If GH
is deficient in children, short stature (below 5 feet) can result.
■ This condition causes 10% of all dwarfism. In adults, there is abnormal body composition,
osteopenia, impaired quality of life, cardiac dysfunction, and an adverse lipid profile.
DEFINITIONS AND BACKGROUND
7. ■ Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) control sexual function
and fertility in males and females.
■ When gonadotropin (FSH, LH) deficiency occurs, men and women will lose interest in
sex and can experience fatigue, weakness, loss of body hair, impotence in men, and loss
of menstruation in women.
■ Oxytocin stimulates the uterus to contract during labor and the breasts to release milk.
■ Oxytocin mechanisms are necessary for successful pregnancies (Kubler et al, 2009).
Pregnancy is uncommon when oxytocin levels are low.
DEFINITIONS AND BACKGROUND
8. ■ Prolactin stimulates female breast development and milk production.
■ Prolactin deficiency is rare but can stop milk production in women.
■ TSH stimulates the thyroid gland to release hormones that affect the body’s metabolism.
■ When TSH is deficient, this can lead to an underactive thyroid (hypothyroidism).
■ Cold intolerance, constipation, weight gain, and pale and waxy or dry skin can occur.
DEFINITIONS AND BACKGROUND
9. INTERVENTION OBJECTIVES
■ Replenish missing hormones.
■ Prevent dehydration, hypoglycemia, and related problems.
■ Improve lean muscle mass stores.
■ Monitor serum levels of cholesterol and triglycerides; prevent vascular complications.
10. FOOD AND NUTRITION
■ Dietary alterations may be needed, such as higher or lower energy intake, until hormone
levels are normalized. A modified fat, cholesterol, and carbohydrate intake may be
needed. Ensure sufficient intake of protein.
■ Six small feedings may be better tolerated than larger meals.
■ Increase fluids unless contraindicated.
■ Ensure adequate intake of all vitamins and minerals. Calcium and vitamin D should be
taken in sufficient amounts to prevent osteoporosis.
11. Common Drugs Used and Potential
Side Effects
■ Hormone replacement therapy may include any of all of the following:
1. Corticosteroids (hydrocortisone [Cortef], cortisol) are often used and can alter glucose,
calcium, and phosphate tolerance. Potassium and folacin must be increased; sodium
must be decreased. Monitor for signs of hyperglycemia.
2. Thyroid preparations (levothyroxine) may be needed.
3. 3. GH (somatotropin) requires no specific dietary interventions. It may help alleviate
elevated triglycerides. Long-term GH replacement therapy in adults is safe for lifelong
therapy in order to maintain the benefits.
4. 4.Estrogen, progesterone, or testosterone replacement should be monitored for side
effects related to heart disease and elevated lipids.
5. 5. Cortisone may be needed during periods of stress or illness if ACTH is deficient.
13. NUTRITION EDUCATION,
COUNSELING,
CARE MANAGEMENT
■ Have patient avoid fasting and stress.
■ Discuss the need to use small, frequent meals instead of large meals.
■ Discuss the possibility of hyperglycemia and how to manage
■ Hormone replacement is usually permanent, so doctor visits will be needed to check for
diabetes and signs of osteoporosis.
16. ■ The parathyroid glands have an overall regulatory role with action as a thermostat in the
systemic calcium homeostasis to ensure tight regulation of serum calcium concentrations
and appropriate skeletal mineralization.
■ Parathyroid hormone (PTH) affects calcium, phosphorus, and vitamin D metabolism by
removing calcium from bone to raise serum levels; it promotes hydroxylation of vitamin D
to its active form.
■ Calcitonin, in contrast to PTH, decreases serum calcium levels; it is secreted by the thyroid
gland.
■ The body secretes PTH in response to hypocalcemia or hypomagnesemia; the hormone
then stimulates osteoclasts to increase bone resorption.
■ PTH also stimulates adenyl cyclase to increase renal tubular calcium resorption and
phosphate excretion.
17. ■ PTH works with vitamin D to regulate total body calcium by activating conversion of 25-
hydroxyvitamin D to 1,25-dihydroxyvitamin D, the active form that stimulates calcium and
phosphate absorption from the GI tract.
■ Calcitonin, in contrast to PTH, decreases serum calcium levels and is secreted by the
thyroid gland.
■ Fibroblast growth factor-23 (FGF23) is a hormone that regulates mineral and vitamin D
metabolism (Juppner, 2009).
■ Research on the effects of various genes and hormones in bone homeostasis is on-
going.
19. DEFINITIONS AND BACKGROUND
■ Hypoparathyroidism results from a deficiency of PTH from biologically ineffective
hormones, damage or accidental removal of the glands, or impaired skeletal or renal
response.
■ In the hereditary form, parathyroid glands are either absent or not functioning properly;
symptoms appear before age 10.
■ Other causes include magnesium deficiency or neonatal immaturity.
■ If untreated, hypoparathyroidism- retardation-dysmorphism (HRD) may result.
20. DEFINITIONS AND BACKGROUND
■ Cancellous bone in hypoparathyroidism is abnormal, suggesting that PTH is required to
maintain normal trabecular structure (Rubin et al, 2010).
■ Hypoparathyroidism with hypocalcemia is one of the most common results of damage to
parathyroid glands during surgery; in fact, it may be diagnosed during a workup for
hypocalcemia.
■ Vitamin D levels may also be deficient.
■ Intraoperative PTH levels are used widely during parathyroidectomy as an indicator of
parathyroid gland function; vitamin D supplementation after surgery may be given to
anticipate decreased parathyroid gland function and to avoid symptomatic hypocalcemia
(Quiros et al, 2005).
21. DEFINITIONS AND BACKGROUND
■ Hypoparathyroidism is a chronic condition that requires lifelong treatment with large
doses of calcium and vitamin D supplements.
■ Episodes of tetany are treated with calcium given intravenously to provide quick relief of
symptoms.
■ Controlled release of physiological concentrations of PTH can be achieved using a
surgically implantable controlled- release delivery system (Anthony et al, 2005).
