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The activity of GH/IGF-I axis in anorexia nervosa and in obesity: A comparison with normal subjects and patients with hypopituitarism or critical illness

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Abstract

GH/IGF-I axis activity changes have been reported both in anorexia nervosa (AN) and in obesity (OB). AN is characterized by GH hypersecretion and very low IGF-I levels as a result of undernutrition and acquired peripheral GH resistance. On the other hand OB is a GH hyposecretory state but IGF-I levels are generally preserved. The activity of GH/IGF-I axis in AN and OB has never been directly compared with that of other pathophysiological condi tions such as hypopituitarism and critical illness in which a reduction of both GH and IGFsecretion has been demonstrated. To this aim, we evaluated IGF-I levels and both basal and GHRH (1 μg/kg) IV-induced GH secretion in 20 female patients with anorexia nervosa (mean age: 19.1±0.8 years) and in 15 female and 5 male patients with simple obesity (mean age 39.0±3.0 years). We then compared the results with those of hypopituitaric patients with severe GH deficiency (GHD), including 10 female and 10 male patients (mean age: 32.0±2.1 years), and with 4 female and 7 male patients with critical illness (CRI) following multiple trau ma 72 hours after ICU admission (mean age: 59.2±1.2 years). Twenty-six normal subjects (NS including 14 female and 12 male patients (mean age: 37.8±3.7 years) were studied as controls Basal IGF-I levels in AN patients (93.5±11 μg/L) were lower (p<0.001) than in the NS (201.7±13.5 μg/L) and OB (194.5±28.6 μg/L), which, in turn, were similar. IGF-I levels in AN patients were lower than in CRI patients (162.8±17.4 μg/L) and higher than in GHD patients (76.7±13.5 μg/L) but these differences did not attain statistical significance. Basal GH levels in AN patients (7.6±2.5 μg/L) were higher (p<0.001) than in NS (1.8±0.3 μg/L), OB patients (1.1±0.5 μg/L), CRI patients (1.8±0.5 μg/L) and GHD patients (0.3±0.1 μg/L), which were the lowest (p<0.01). The GHRH-induced GH rise in AN patients (AUC: 2032.9±253.5 μg/L/h) was three fold higher (p<0.001) than in NS (662.1±80.3 μg/L). On the other hand in OB (332.4±74.7 μg/L/h) the GH response to GHRH was similar to that in CRI (199.6±98.8 μg/L/h); both were clearly higher (p<0.01) than in GHD patients (25.1±5.2 μg/L/h) but lower (p<0.01) than in NS These findings demonstrate that in AN patients, in spite of a clear increase of both basal and GHRH-induced GH secretion, IGF-I synthesis and release are as markedly impaired as in patients with panhypopituitarism and severe GHD. On the other hand in OB and in CRI, IGFsynthesis and release are preserved despite marked impairment to GHRH-induced GH secre tion. These results reinforce the major role of nutrition in conditioning the activity of GH/IGFaxis in different patho-physiological states.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, University of Torino, C.so Dogliotti 14, 10126, Torino, Italy

    L. Gianotti, F. Broglio, J. Ramunni, F. Lanfranco, C. Gauna, A. Benso, E. Arvat &  E. Ghigo

  2. Intensive Care Unit, Bellaria Hospital, Bologna, Italy

    M. Zanello

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  1. L. Gianotti
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Gianotti, L., Broglio, F., Ramunni, J. et al. The activity of GH/IGF-I axis in anorexia nervosa and in obesity: A comparison with normal subjects and patients with hypopituitarism or critical illness. Eat Weight Disord 3, 64–70 (1998). https://doi.org/10.1007/BF03339990

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