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Assessment of GH/IGF-I axis in obesity by evaluation of IGF-I levels and the GH response to GHRH+arginine test

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Abstract

The GH response to provocative stimuli in obese is often as low as in panhypopituitaric patients with severe GHD; however, IGF-I levels are normal or slightly reduced. In 53 patients with simple obesity (11 M and 42 F, age: 40.3±1.6 yr, BMI: 39.1±1.0 Kg/m2), we evaluated the GH response to GHRH (1 μg/kg iv)+arginine (ARG, 0.5 g/kg iv), and total IGF-I levels. The mean (±SE) GH peak after GHRH+ARG was markedly lower (74% reduction, p<0.0001) in obese (16.8±2.0 μg/l) than in normal subjects (62.7±4.3 μg/l). IGF-I levels in obese patients (134.0±7.6 μg/l) were lower (33% reduction, p<0.001) than in normal subjects (200.8±5.7 μg/l). Taking into account the 3rd centile limit of normal response, the GH response to GHRH+ARG was reduced in 62.3% (33/53) of the obese patients, and 21.2% (7/33) of them had low IGF-I levels. Assuming the 1st centile limit, it was reduced in 33.9% (18/53) obese subjects, and 22% (4/18) of them had low IGF-I levels. Considering 3.0 μg/L as arbitrary cut-off, the GH response was reduced in 5.7% (3/53) of the obese patients, and still one of them had low IGF-I levels. Our findings: a) confirm that the secretory capacity of somatotroph cells is often deeply impaired in obesity; b) demonstrate that IGF-I assay generally rules out severe impairment of GH/IGF-I axis in obese patients with marked reduction of the GH secretion; c) indicate that the percentage of obese patients with concomitant reduction of GH secretion and IGF-I levels is not negligible. Thus, IGF-I assay should be routinely performed in obese patients; those presenting with low IGF-I levels should undergo further evaluation of their hypothalamo-pituitary function and morphology, particularly in the presence of empty sella.

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Authors and Affiliations

  1. Divisione di Endocrinologia, Dipartimento di Medicina Interna, University of Torino, C.so Dogliotti 14, 10126, Torino, Italy

    M. Maccario, C. Gauna, M. Procopio, L. Di Vito, R. Rossetto, S. E. Oleandri, S. Grottoli, C. Ganzaroli, G. Aimaretti & E. Ghigo M.D.

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  1. M. Maccario
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  2. C. Gauna
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  3. M. Procopio
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  4. L. Di Vito
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  5. R. Rossetto
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  6. S. E. Oleandri
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  7. S. Grottoli
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  8. C. Ganzaroli
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  9. G. Aimaretti
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  10. E. Ghigo M.D.
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Maccario, M., Gauna, C., Procopio, M. et al. Assessment of GH/IGF-I axis in obesity by evaluation of IGF-I levels and the GH response to GHRH+arginine test. J Endocrinol Invest 22, 424–429 (1999). https://doi.org/10.1007/BF03343585

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