MULTIPLE ENDOCRINE ABNORMALITIES OF THE GROWTH-HORMONE AND INSULIN-LIKE-GROWTH-FACTOR AXIS IN PATIENTS WITH ANOREXIA-NERVOSA - EFFECT OF SHORT-TERM AND LONG-TERM WEIGHT RECUPERATION

We have studied the GH-insulin-like growth factor (IGF) axis in patien ts with anorexia nervosa at the time of diagnosis and at two points du ring weight recuperation. We report their spontaneous GH secretion and IGF-I, free IGF-I (fIGF-I), IGF-II, the IGF-binding proteins (IGFBP-1 , IGFBP-2, and IGFBP-3), and GH-binding protein (GHBP) levels at the t ime of the clinical diagnosis (n = 50) and after recuperation of betwe en 6-8% (n = 42) and 10% or less of the initial weight (n = 20). Two d istinct groups were seen, those who significantly hypersecreted GH and those whose GH secretion was reduced significantly. After recuperatio n of 10% or more of their initial weight, all patients had a normal GH pattern. Independently of GK secretory dynamics, IGF-I, IGFBP-3, and GHBP serum levels were all significantly decreased at diagnosis, and o nly GHBP returned to normal after weight recuperation. Serum IGFBP-1 a nd IGFBP-2 levels were significantly increased at the time of diagnosi s and decreased after weight recuperation. The body mass index (BMI) c orrelated positively with fIGF-I levels and negatively with IGFBP-1 an d IGFBP-2 levels, but only after weight recuperation in all cases. Con trary to what is seen in normal individuals, no correlation was found between BMI and serum GHBP levels in anorexia nervosa patients. Serum IGFBP-2 levels had a strong negative correlation with fIGF-1, IGF-II, and the sum of IGF-I and IGF-II, but only at the time of diagnosis. In conclusion, the GH-IGF axis is dramatically altered in patients with anorexia nervosa. Changes in the peripheral IGF system, however, appea r to be independent of modifications in GH secretion and, in contrast to current thought, not all of the observed abnormalities are rapidly reversed with weight recuperation.