endocrine nutrition

1. HYPOPITUITARISM
AND NUTRITIONAL
MANAGEMENT

2. 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.

3. 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. ■ 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

6. ■ 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

7. ■ 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

8. 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.

9. 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.

10. 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.

11. Herbs, Botanicals, and
Supplements
■ Herbs and botanical supplements should not be used without discussing with physician.

12. 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.

13. Patient Education—Foodborne
Illness
■ If home tube feeding is needed, teach appropriate sanitation and food-handling
procedures.

14. ACROMEGALY AND
NUTRITION

15. DEFINITIONS AND BACKGROUND
■ Acromegaly is a hormonal disorder caused by overproduction of human GH by the
pituitary gland.
■ Incidence is rare, with 50–70 cases per million in the U.S. population.
■ Diagnosis is made common about a decade after oversecretion of GH begins.
■ If GH-producing tumors occur in puberty, the condition is called gigantism.
■ Genetics and nutrition impact the height of most children; unusual, continuing growth in
stature beyond the twenties should be evaluated.

16. DEFINITIONS AND BACKGROUND
■ GH (somatotropin) affects the growth of almost all cells and tissues and has direct and
indirect effects.
■ Direct effects of excessive GH include hyperinsulinism, lipolysis, insulin resistance in
peripheral tissues, ketogenesis, hyperglycemia, and sodium and water retention.
■ In over 98% of cases, overproduction of GH is related to a benign pituitary tumor.
■ In a few patients, acromegaly is caused by tumors of the pancreas, lungs, or adrenal
glands.
■ Symptoms and signs of acromegaly include enlarged extremities with disproportionate
growth of nose, lips, brow, lower jaw, tongue, hands, and feet.
■ Serious side effects include heart failure, colon polyps that become cancerous, and
diabetes.

17. DEFINITIONS AND BACKGROUND
■ Elevated insulin-like growth factor I (IGF-I) also occurs in acromegaly, resulting in greater
protein synthesis, amino acid transportation, muscle and bone growth, DNA and RNA
synthesis, and cell proliferation.
■ High levels of GH and increased IGF-1 levels (three to ten times above normal) may be used
to diagnose acromegaly.
■ Hormone-secreting pituitary tumors account for about 30% of all pituitary tumors (Patil et
al,2009).
■ Surgical removal of the pituitary gland provides a 50–70% chance of cure (Vance and Laws,
2005).
■ Acromegaly is complicated by an increased incidence of diabetes mellitus caused by impaired
insulin sensitivity and reduced beta cell function (Higham et al, 2009).
■ Bone and cartilage growth may lead to arthritis. Acromegalic patients present with
hypoadiponectinemia; studies suggest a link between adiponectin, visfatin, fat mass, and
bone changes (Sucunza et al, 2009).

18. DEFINITIONS AND BACKGROUND
■ Premature death may result if left untreated.
■ Treatment may include surgical removal of the tumor, radiation therapy, or injection of a
GH blocking drug.
■ Somatostatin analogs have been key in medical therapy.
■ Pegvisomant, a GHreceptor antagonist, competitively binds to the GH receptor, blocking
IGF-I production and allowing for a better control of cardiac disorders and glucose
metabolism (Vance and Lawes, 2005).
■ Improved insulin sensitivity occurs after use from a reduction in overnight endogenous
glucose production (Higham et al, 2009).
■ Somatuline Depot (lanreotide) can be used for a long-term treatment in patients who
have had an inadequate response to surgery and/or radiation.

19. INTERVENTION OBJECTIVES
■ Control weight.
■ Prevent or control diabetes, hypertension, or heart disease when present.
■ Prevent osteoporosis with calcium balance, which is often negative.
■ Monitor for complications such as colon polyps, which may lead to cancer.

20. FOOD AND NUTRITION
■ An CHO-controlled diet may be needed if diabetes is present.
■ Extra fluid intake may be needed.
■ Control sodium and fluid intake if there is heart failure.
■ Offer sufficient intake of calcium and vitamin D; a multivitamin–mineral supplement may
be useful.

21. Common Drugs Used and Potential
Side Effects
■ Bromocriptine (Parlodel) can be taken orally to reduce GH secretion. Side effects include
gastrointestinal upset, nausea, vomiting, light-headedness when standing, and nasal
congestion. Take with food.
■ Octreotide (Sandostatin) injection is a synthetic form of somatostatin. Side effects include
diarrhea, nausea, gall- stones, and loose stools.
■ Insulin may be needed if diabetes is also present. Be wary of excess doses; hypoglycemia
is a dangerous side effect.