Dietary Interventions and Vitamin D3 Replacement in Pituitary Tumors: a Systematic Review

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ID: 329228
2026
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Abstract
Abstract Objective Pituitary neuroendocrine tumors (PitNETs) cause hormonal imbalances that impair metabolic health and quality of life (QoL). Dietary interventions may mitigate these comorbidities. This review evaluated the effectiveness of dietary strategies in improving disease-related metabolic, and bone outcomes in patients with PitNETs. Design Systematic review of interventional and observational studies on dietary interventions in acromegaly, Cushing’s disease, prolactinomas, and hypopituitarism. Methods A systematic search was performed on January 20th, 2026. Eligible studies assessed dietary interventions targeting metabolic or bone-related outcomes. Risk of bias was evaluated using ROBINS-I and the Newcastle–Ottawa Scale. Extracted outcomes included dietary intake, body composition, metabolic parameters, biochemical control, and bone health. Results Of 2,256 screened records, eight studies (355 participants) met the inclusion criteria, including five interventional and three observational studies. In acromegaly, an isocaloric very low-carbohydrate ketogenic diet (VLCKD) reduced IGF-I levels. In Cushing’s disease, VLCKD and energy-restricted diets (ERD) improved BMI and metabolic parameters. In prolactinoma, ERD combined with increased physical activity improved weight and biochemical control. In hypopituitarism, ERD with increased physical activity and sibutramine improved body composition and metabolic outcomes. Vitamin D replacement reduced vertebral fracture risk in acromegaly and improved insulin sensitivity and lipid levels in Cushing’s disease. Conclusions Evidence on dietary strategies for PitNET management is limited. Low-carbohydrate and energy-restricted diets may improve adverse metabolic comorbidities, while vitamin D3 replacement shows potential benefits for insulin sensitivity in Cushing’s disease and fracture risk in acromegaly. Larger randomized trials are needed to confirm effects on disease control, comorbidities, and QoL.
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Authors L C te Nijenhuis-Noort, Romy van der Groef, Julie Refardt, Iris C. M. Pelsma, Nienke R. Biermasz, K A Berk, S J C M M Neggers
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Journal european journal of endocrinology
Year 2026
DOI
10.1093/ejendo/lvag182
URL
https://doi.org/10.1093/ejendo/lvag182
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