Decreased Growth Hormone Secretion Research Articles

Structural Analysis of Human Growth Hormone with Respect to the Dominant Expression of Growth Hormone (GH) Mutations in Isolated GH Deficiency Type II

Human GH protein consists of four alpha-helices and contains two disulfide bridges. Isolated GH deficiency type II (IGHD II) is mainly caused by heterozygous splice site mutations of GH-1 leading to the disruption of one disulfide bridge (Cys53-Cys165) and to the loss of amino acids (aa) 32-71, which comprise the complete loop between alpha-helices 1 and 2. The mutant GH protein exerts a dominant negative effect on wild-type (wt) GH secretion by unclear mechanisms. For study of the structure-function relationship of GH mutants concerning the dominant negative effect, expression vectors harboring mutated GH cDNAs were transiently cotransfected with a vector encoding wtGH (pwtGH) into GH4C1 cells. Plasmids encoding beta-galactosidase, luciferase, or IGF-binding protein-2 were cotransfected with pwtGH and either of the GH mutants. Compared with the control transfection with pwtGH, GH secretion was mildly decreased by coexpressing wtGH and different GH point mutants with isolated disruption of the disulfide bridge Cys53-Cys165. Similar results were observed with GH mutants deleted in aa 32-46 or 32-52. Deletion of more aa (32-53, 32-63, 32-69, 32-71) ascendingly decreased GH secretion and content in parallel with the increasing length of the deleted stretch. An inhibitory dose-dependent effect of del32-69GH and del32-71GH on the activity/amount of coexpressed beta-galactosidase, luciferase, and IGF-binding protein-2 was found, whereas mRNA levels were unaffected. Hence, the extent of deletion played the major role in expression of the dominant negative effect. The inhibitory effect of GH mutants on heterologously expressed, non-GH proteins suggests that the dominant negative effect is not limited to GH or to proteins of the regulated secretory pathway, but may depend on expression levels.

AUGMENTATION OF AGE·RELATED CHANGES OF SOMATOTROPHS OF LIFE-LONG MELATONIN DEFICIENT RATS

Many studies indicate connection between pineal gland function ami growth hormone (GH)-insulin-like growth factor (lOF-I) axis in mammals, but their results are not always synonymous (Nir, 1978; Mess, 1983), Pinealcctomy abolishes a decrease of GH concentration in the pituitary gland-of rats, as well as in plasma caused by constant darkness (Relkin, 1972). Ronnekleiv and Me Cann (1978) detected the decrease of GH secretion in rats after pinealcctomy during the day and a lack of the effect at night. Other investigators indicated intensification of circadian fluctuations of GR after pincalcctomy in rats with small increase of daily secretion (Niles et aI., 1979).Progressive and irreversible physiological decline is a characteristic of all organisms late in life, Many studies indicating functional alterations in pars distalis cells accmpanied with aging (Mitchell et at, 1995; Velasco et aI., 1998; Velduis,2000). Pinealcctomy is known to result in a clear decrease in the concentration of circulating melatonin (Gauer et al., 1992). Growth hormone rhythm was suppressed in the pinealectomized rats (Ostrowska et al., 2001). The dysfunctional processes that are a result of macromolecular damage constitute what is referred to as the free radical theory of aging (Sohal and Weindruch, 1996), Numerous reports documented protective actions of melatonin in various modelsof oxidative stress (El-Sokkary et al., 1999; Lee et al., 2002). This is due to its high efficacy as a free radical scavenger and indirect antioxidant (Tan et al., 2002). Additionally, melatonin stimulates the activities of enzymes that metabolize reactive species (Reiter et aI., 2000) and maintains cell membrane fluidity at an optimal level (Garcia et al., 1998). Melatonin was found to decrease with aging (Lee et aI., 2002). Reiter et al. (1999) reported that aging in the pineal-intact animals was associated with increased levels of lipid peroxidation (in the lung, kidney and skin). togethcrwith rises in an oxidatively damaged DNA (in liver, kidney and pancreas), and in the levels of protein carbonyls (in the liver). Likewise, advanced age was associated with a significant decrease in membrane fluidity of hepatic rnicrosomcs inpineal-intact rats. For all of these parameters and in a number of organs, pinealectomy caused further increase in the indices of oxidative damage. The aim of this work was to investigate the ultrastructural alterations in somatotrophcells that result from melatonin deficiency in aged (Pineal-intact) rats and to test whether further induced reduction of melatonin by pinealectomy augment these alterations, trying to detect the role of mclaronin in the aging process.

Effect of withdrawal of somatostatin plus growth hormone (GH)-releasing hormone as a stimulus of GH secretion in Cushing's syndrome.

Somatostatin (SS) may not merely be inhibitory to GH secretion but, under appropriate temporal conditions, may act in a paradoxically positive manner to sensitize somatotroph responsiveness to GHRH. SS infusion withdrawal (SSIW) produces a rebound GH rise in humans and increases GHRH-induced GH release. Theoretically SSIW leaves the somatotroph cell in a situation of low endogenous SS. In Cushing's syndrome, GH secretion appears blunted to all stimuli. The mechanisms by which glucocorticoids impair GH secretion in Cushing's syndrome are unknown. There are no data evaluating GH responsiveness to SSIW plus GHRH in Cushing's syndrome patients. The aim of the present study was to evaluate the GH response to SSIW plus GHRH in a group of Cushing's syndrome patients, in order to further understand the deranged GH secretory mechanisms in Cushing's syndrome. Eight female patients with Cushing's syndrome were studied. As a control group, eight normal subjects of similar age and sex were studied. Three tests were done. On one day, SS intravenous (i.v.) infusion (500 micro g for 0-90 min) was performed followed by placebo i.v. bolus at min 90 after SS withdrawal (SSIW). On another day, SS i.v. infusion (500 micro g for 0-90 min) was performed followed by GHRH (100 micro g) i.v. bolus at min 90 after SS withdrawal. On a third day, slow infusion of 150 mmol/l NaCl administration was performed followed by GHRH (100 micro g) i.v. bolus at min 90 after the start of the infusion. Blood samples were taken at appropriate intervals for determination of GH. GHRH-induced GH secretion in normal subjects showed a mean peak of 15.4 +/- 2.1 micro g/l (conversion factor: 1 micro g/l = 1.2 mUI/l). Normal control subjects had a mean peak of 3.3 +/- 1.6 micro g/l after SSIW-induced GH secretion. When GHRH was administered after SSIW there was increased GH secretion with a mean peak of 23.7 +/- 4.2 micro g/l significantly greater than the response after SSIW alone (P < 0.05) and GHRH alone (P < 0.05). The patients with Cushing's syndrome had a blunted GH response after GHRH administration with a mean peak of 1.4 +/- 0.4. After SSIW, Cushing's syndrome patients had a mean peak of 1.0 +/- 0.5 micro g/l. When GHRH was administered after SSIW there was a similar GH response with a mean peak of 1.7 +/- 0.6 micro g/l, not statistically different than the response after SSIW alone (P = ns) and GHRH alone (P = ns). When we compare the response of normal subjects and Cushing's syndrome patients, after SSIW plus GHRH, it was decreased in Cushing's syndrome patients (P < 0.05), with a mean GH peak of 23.7 +/- 4.2 micro g/l and 1.7 +/- 0.6 micro g/l for normal subjects and Cushing's syndrome patients, respectively. This study has demonstrated a significantly blunted peak GH response to somatostatin infusion withdrawal plus GHRH in Cushing's syndrome patients. In this theoretical situation of decreased somatostatinergic tone there is persistence of GH hyposecretion in Cushing's syndrome, suggesting the existence of a pituitary defect responsible for the decreased GH secretion in Cushing's syndrome.

Cachexia in rheumatoid arthritis is not explained by decreased growth hormone secretion.

Patients with rheumatoid arthritis (RA) lose body cell mass (BCM) by unknown mechanisms. Since the loss of BCM in normal aging individuals parallels the characteristic age-related decline in growth hormone (GH) secretion, this study was carried out to determine whether further decreased GH secretion plays a role in the pathogenesis of this loss of BCM in RA patients, termed "rheumatoid cachexia." GH secretory kinetics were determined by deconvolution analysis in 16 patients with RA and 17 healthy controls matched for age (mean +/- SD 45.4 +/- 13.2 years and 47.1 +/- 14.6 years, respectively), sex, race, and body mass index. Blood samples were obtained every 20 minutes for 24 hours. Body composition was ascertained using total-body potassium (TBK) as a measure of BCM and dual x-ray absorptiometry to determine fat mass. BCM was reduced in patients with RA compared with healthy controls (mean +/- SD gm TBK 79.5 +/- 9.5 versus 94.9 +/- 11.9; P < 0.0005), but there was no difference in fat mass. GH kinetic parameters in patients with RA did not differ from those in controls. These findings suggest that GH kinetics are unaltered in RA patients compared with healthy subjects; thus, GH deficiency does not account for rheumatoid cachexia.

Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings.

Exercise is a potent physiological stimulus for growth hormone (GH) secretion, and both aerobic and resistance exercise result in significant, acute increases in GH secretion. Contrary to previous suggestions that exercise-induced GH release requires that a "threshold" intensity be attained, recent research from our laboratory has shown that regardless of age or gender, there is a linear relationship between the magnitude of the acute increase in GH release and exercise intensity. The magnitude of GH release is greater in young women than in young men and is reduced by 4-7-fold in older individuals compared with younger individuals. Following the increase in GH secretion associated with a bout of aerobic exercise, GH release transiently decreases. As a result, 24-hour integrated GH concentrations are not usually elevated by a single bout of exercise. However, repeated bouts of aerobic exercise within a 24-hour period result in increased 24-hour integrated GH concentrations. Because the GH response to acute resistance exercise is dependent on the work-rest interval and the load and frequency of the resistance exercise used, the ability to equate intensity across different resistance exercise protocols is desirable. This has proved to be a difficult task. Problems with maintaining patent intravenous catheters have resulted in a lack of studies investigating alterations in acute and 24-hour GH pulsatile secretion in response to resistance exercise. However, research using varied resistance protocols and sampling techniques has reported acute increases in GH release similar to those observed with aerobic exercise. In young women, chronic aerobic training at an intensity greater than the lactate threshold resulted in a 2-fold increase in 24-hour GH release. The time line of adaptation and the mechanism(s) by which this training effect occurs are still elusive. Unfortunately, there are few studies investigating the effects of chronic resistance training on 24-hour GH release. The decrease in GH secretion observed in individuals who are older or have obesity is associated with many deleterious health effects, although a cause and effect relationship has not been established. While exercise interventions may not restore GH secretion to levels observed in young, healthy individuals, exercise is a robust stimulus of GH secretion. The combination of exercise and administration of oral GH secretagogues may result in greater GH secretion than exercise alone in individuals who are older or have obesity. Whether such interventions would result in favourable clinical outcomes remains to be established.

Regulation of chicken embryonic growth hormone secretion by corticosterone and triiodothyronine: evidence for a negative synergistic response.

We reported that growth hormone (GH)-secreting cells differentiated by d 16 of chick embryonic development and that these somatotrophs were responsive to GH-releasing hormone and thyrotropin-releasing hormone. The present experiments evaluated effects of corticosterone and triiodothyronine (T3) on embryonic GH secretion. Anterior pituitary cells from embryonic day (e) 16, e18, and e20 were subjected to reverse hemolytic plaque assays (RHPAs) for GH in the absence or presence of corticosterone or T3. Corticosterone increased GH secretion from embryonic somatotrophs, an effect particularly evident on e16 and e18. T3 decreased GH secretion on e16, while no effect of T3 was significant on e18 or e20. Next, pituitary cells were subjected to RHPAs with T3 and corticosterone alone or in combination. Combined treatment with these hormones suppressed GH secretion from e16, e18, and e20 somatotrophs to levels below those found under basal conditions. We conclude that corticosterone can stimulate GH secretion in vitro at all embryonic ages tested. Furthermore, T3 can suppress basal GH secretion on e16, and the combination of T3 and corticosterone can suppress GH secretion at all ages. These findings indicate that GH secretion during the end of chicken embryonic development may be regulated by the interactions of endogenous glucocorticoids and thyroid hormones that increase prior to hatching.

Sustained benefit after 2 years of growth hormone on body composition, fat utilization, physical strength and agility, and growth in Prader-Willi syndrome

Background: Obesity and hypotonia in children with Prader-Willi syndrome (PWS) are accompanied by abnormal body composition resembling a growth hormone (GH)-deficient state. Hypothalamic dysfunction in PWS includes decreased GH secretion, suggesting a possible therapeutic role for GH treatment. Although recent studies have demonstrated short-term benefits of treatment with GH, a critical question is whether beneficial changes persist or wane with prolonged therapy. Objectives and methods: Effects of 24 months of GH treatment (1 mg/m2/d) on growth, body composition, strength and agility, pulmonary function, resting energy expenditure, and fat utilization were assessed in 35 children with PWS. Percent body fat, lean muscle mass, and bone mineral density were measured by dual-energy x-ray absorptiometry. Indirect calorimetry was used to determine resting energy expenditure and to calculate the respiratory quotient. Results: Compared with baseline evaluations, increased height velocity (SD score –1.1 ± 2.5 to 2.2 ± 2.3; P <.001), reduced percent body fat (46.4% ± 8.4% to 40.3% ± 10.0%, P <.001), and improved respiratory muscle function and physical strength and agility (sit-ups, weight-lifts, running speed, and broad jump; P <.01) were observed after 24 months of GH treatment. A decline in respiratory quotient (0.81 ± 0.07 to 0.75 ± 0.06; P <.01) and a trend toward increased resting energy expenditure were also observed. Changes in response to GH occurred predominantly during the initial 12 months of GH therapy. Conclusions: Children with PWS had sustained increases in lean body mass, decreases in percent body fat, improvements in physical strength and agility, and increased fat oxidation after 24 months of GH therapy. However, between 12 and 24 months, the growth rate slowed. Consequently, encouraging initial results require even more prolonged study to draw conclusions regarding the long-term value of GH therapy in changing body composition in children with PWS. (J Pediatr 2000;137:42-9)

Predictors of Growth Hormone Secretion in Aging

Growth hormone (GH) secretion decreases progressively after mid-puberty in both men and women. This decrease occurs predominantly before age 40–50 and affects both daytime and nocturnal GH secretion. A reduction in the amplitude of GH secretory pulses accounts for the majority of the reduction in GH secretion. With aging, changes in hypothalamic function may occur that result in decreased GH secretion. These changes may include decreased secretion of GH-releasing hormone and/or the putative natural ligand for the GH secretagogue receptor or an increase in somatostatin release. Multiple physiological factors have been reported to regulate GH secretion including sleep, body composition (% body fat and amount of abdominal visceral fat), aerobic physical fitness and serum concentrations of insulin-like growth factor-I (IGF-I), gonadal steroids and insulin. Changes in these factors with aging may contribute to the reduction in GH secretion observed in older adults. However, these physiological predictors of GH...

Growth hormone and the aging male

Growth hormone (GH) exerts a crucial role in promoting somatic growth. In addition, GH constitutes a major regulator of body composition, bone and muscle metabolism, and cardiac function, and actually acts as a prime modulator of fuel metabolism. GH secretion is maximal during puberty. Thereafter, GH secretion falls in young adulthood to less than half the values achieved in mid- to late puberty. This decline is exponential, with a t1/12 of approximately 7 years, and is essentially complete by the beginning of the fifth decade. The origin of this decrease is likely to be multifactorial but the underlying mechanisms remain largely speculative. Since aging and ‘true’ GH deficiency due to pituitary disorders are associated with similar somatic features, it has been suggested that in older healthy subjects, these features result from relative GH-insulin-like growth factor-I (IGF-I) deficit and represent a syndrome that has been named somatopause. So far, however, the causal link between these somatic features and decreased GH secretion has not been proven. Therefore, the question remains as to whether the aim of restoring GH levels to the normal young range is legitimate. If that was the case, experimental approaches which might mimic natural GH secretory patterns and improve sleep quality, such as GH secretagogues, would appear more promising than GH administration, and futher clinical trials should be peformed in men 40–60 years old.

Unexpected Activation of Pituitary-Adrenal Axis in Healthy Young and Elderly Subjects during Somatostatin Infusion

In this study we explored, in man, the effect of acute attenuation of growth hormone (GH) release induced by somatostatin (SRIH) on ACTH and cortisol plasma levels. Sixteen young (8 women, aged 23–32 years, and 8 men, aged 18–27 years) and 14 elderly (8 women, aged 65–82 years, and 6 men, aged 65–70 years) healthy subjects volunteered to participate in this investigation. Each subject was tested on two separate occasions by: (1) a 90-min i.v. infusion of SRIH given in 50 ml 0.9% saline delivered at a rate of 9 µg/kg/h, and (2) a 90-min i.v. infusion of isovolumetric amounts of 0.9% saline. Plasma GH, ACTH, cortisol and glucose concentrations were determined prior and up to 180 min after SRIH or saline infusion. SRIH induced a significant (p < 0.05) decrease in plasma GH levels from basal values of 0.6 ± 0.15 and 0.5 ± 0.15 µg/l to nadir values 0.25 ± 0.1 and 0.2 ± 0.1 µg/l in young and elderly subjects, respectively. The administration of SRIH was associated with a clear-cut increase in plasma ACTH levels both in young (peak, 10.6 ± 1.6 pmol/l; AUC, 558.6 ± 147.5 pmol/l/h) and in elderly (peak, 21.3 ± 5.6 pmol/l; AUC, 841.9 ± 153.8 pmol/l/h) subjects with a significant (p < 0.01) difference as compared to saline infusion. Consistent with these results, SRIH infusion resulted in an unequivocal rise in plasma cortisol levels both in young (peak, 394.8 ± 36.4 nmol/l; AUC, 18,591.62 ± 1,372.45 nmol/l/h) and in elderly (peak, 585.6 ± 51.5 nmol/l; AUC, 24,871.05 ± 1,837.03 nmol/l/h) subjects. The ACTH and cortisol responses to SRIH were significantly (p < 0.05 and p < 0.01) higher in elderly than in young subjects. No sex-related differences occurred in the SRIH-induced activation of hypothalamic-pituitary-adrenocortical (HPA) axis. We conclude that (1) infusion of SRIH, at a dose that inhibited basal GH secretion, was associated with an activation of HPA axis, and (2) this response was higher in elderly individuals compared with younger adults. The reason for this novel and unexpected SRIH effect is presently unclear; however, the latter may be mediated, at least in part, by some central nervous system ACTH-releasing mechanisms activated by SRIH-induced decrease in GH secretion.

Disturbances of growth hormone-insulin-like growth factor axis and response to growth hormone in acidosis.

Severe chronic metabolic acidosis (CMA) in rats is associated with poor food intake and downregulation of growth hormone (GH), insulin-like growth factors (IGFs), and liver receptors; the administration of recombinant GH (rGH) fails to improve the growth failure. In mice with carbonic anhydrase II deficiency (CAD), a model of moderate CMA with food intake close to normal, we studied serum levels of GH, IGFs, and IGF-binding proteins, and the growth response to rGH. CAD was associated with low serum levels of GH in males. Randomized administration of rGH from approximately 5 to approximately 12 wk to CAD mice improved food efficiency and increased serum IGF-I levels, final length, and weight compared with placebo without affecting blood pH. Although administration of rGH also increased linear growth in healthy animals, the effect was less than that in CAD mice and was only observed when started before 6 wk of life. Thus growth failure in CAD mice is associated with a decrease in GH secretion in males but not in females. Long-term administration of rGH increases linear growth in CAD mice despite persistent CMA.

Occult neurohypophyseal germinomas in patients presenting with central diabetes insipidus

Although neurohypophyseal germinoma is known be a common initial symptom in cases of diabetes insipidus (DI), its radiological detection may take months or years even by a high-resolution magnetic resonance (MR) imaging. The term "occult neurohypophyseal germinoma" denotes such cases, but its clinical picture remains obscure. Of seven patients with neurohypophyseal germinoma presenting with DI during the last 5 years, three patients showed no evidence of tumor at the onset of DI and were treated as "idiopathic" DI. Neurohypophyseal germinoma was eventually diagnosed in these three patients as the tumor became evident on sequential MR imaging studies and the patients were successfully treated with chemotherapy and radiation therapy. To delineate the clinical features of the occult neurohypophyseal germinoma, the authors analyzed endocrinological aspects and MR images in these patients and compared them with those in two patients with true idiopathic DI and four patients with overt neurohypophyseal germinoma and DI. Nine previously reported cases in the literature were reviewed. During the stage at which the germinoma gave no notable change on MR images, patients often displayed anterior pituitary dysfunction, particularly growth hormone (GH) deficiency, or an elevation of serum or cerebrospinal fluid human chorionic gonadotropin-beta. Preceding the appearance of an obvious tumor mass, a slight swelling of the pituitary stalk with loss of normal hyperintensity of the posterior pituitary lobe was a common finding on MR imaging. Central DI associated either with an enlarged stalk, decreased GH secretion, or an elevated serum human chorionic gonadotropin-beta should prompt the diagnosis of an occult germinoma.

Decreased growth hormone response to glucagon in infants after an apnea of infancy

We studied glucagon-induced growth hormone secretion in 9 patients with apnea of infancy and in 55 siblings of children who had died of sudden infant death syndrome, who were included as a comparison group. We observed a 33% decrease in growth hormone secretion in patients with apnea of infancy. However, linear growth remained normal. This finding could be related to either repeated episodes of hypoxia or to abnormal maturation of the autonomous nervous system. (J Pediatr 1998;132:452-4)

RhIGF-I administration reduces insulin requirements, decreases growth hormone secretion, and improves the lipid profile in adults with IDDM

rhIGF-I administration reduces insulin requirements, decreases growth hormone secretion, and improves the lipid profile in adults with IDDM

Severe uremia depresses the ability of perifused rat pituitary cells to secrete growth hormone in response to growth hormone releasing hormone.

To examine whether growth hormone (GH) secretion is impaired by chronic renal failure (CRF) and to gain some insight into the influence of uremia itself and associated malnutrition, the GH secretory response of dispersed anterior pituitary cells perifused with GH-releasing hormone (GHRH) was investigated in 5/6 nephrectomized (UREM, N = 15) and three groups (N = 15 each) of normal renal function, sham-operated rats under three different nutritional conditions: fed "ad libitum" (SAL), pair-fed with a diet similar to the UREM group (SPF), and pair-fed with a diet similar to the UREM group in terms of protein ingestion but calorically supplemented up to intake of SAL group (SPF+). Ten days after nephrectomy, UREM rats had severe CRF, as shown by much higher (P < 0.0001) serum urea nitrogen concentrations (X +/- mean +/- SE) than sham groups (59 +/- 6 versus 8 +/- 0, 9 +/- 0, and 5 +/- 0 mmol/L, respectively), and they were growth retarded, as shown by lower gains (P < 0.0001) in weight (13.5 +/- 2.5 versus 62 +/- 2.1, 20.5 +/- 1.9, and 50.4 +/- 1.0 g) and length (2.9 +/- 0.2 versus 5.8 +/- 0.1, 3.6 +/- 0.1, and 5.6 +/- 0.1 cm). Perifusion studies showed similar basal GH secretory rate (ng/min/10(7) cells) in the four groups. A fixed sequence of progressively increasing GHRH doses resulted in a lower overall mean GH secretion in UREM rats (15.8 +/- 1.6 ng/min/10(7) cells), as compared with SAL (50.8 +/- 9.0 ng/min/10(7) cells, P < 0.01), SPF (33.0 +/- 3.3 ng/min/10(7) cells, P < 0.05), and SPF+ (49.4 +/- 5.1 ng/min/10(7) cells, P < 0.01) groups. Analysis of dose-response curves showed that the maximal secretory response was produced by the same concentration of GHRH (10 nM) in the four groups and was lower (P < 0.01) in UREM than SAL and SPF+ rats (34.9 +/- 5.0 versus 115.7 +/- 28.4 and 98.9 +/- 9.8 ng/min/10(7) cells). The concentration of GHRH that caused the half of maximal effect was identical, close to 1 nM, in the four groups of animals. This study provides direct evidence that the ability of pituitary cells to secrete GH in response to GHRH is depressed in severe CRF. The lower secretory capacity of pituitary gland is only partly dependent on caloric malnutrition associated with CRF. Data of dose-response curves suggest that decreased GH secretion may be related to a lesser number of pituitary receptors for GHRH.

Bone mineral metabolism in girls with precocious puberty during gonadotrophin-releasing hormone agonist treatment.

Bone mineral metabolism and mineralization before and during treatment were studied in 10 girls aged 6.9-8.4 years affected by central precocious puberty and treated with gonadotrophin-releasing hormone agonist (GnRHa) leuprolide acetate depot, in order to understand better the consequences of oestrogen deficiency and the reduction of growth hormone (GH)-insulin-like growth factor I (IGF-I) axis activity. Before and after 12 months of therapy, the patients underwent a clonidine stimulation test and a 4-day calcitriol osteoblast stimulation test. On day 0, day 5 and at 3-month intervals thereafter, serum calcium, phosphate, alkaline phosphatase, IGF-I, IGF binding protein 3 (IGFBP-3), GH, GH binding protein and osteocalcin levels were measured; urinary calcium, phosphate and hydroxyproline levels were evaluated in fasting spot samples. Trabecular and cortical bone mass variations, measured by dual X-ray absorptiometry in the lumbar spine and by dual photon absorptiometry in the radius, respectively were evaluated before the start and after 12 months of therapy. During treatment, a decrease of serum oestradiol levels from pubertal to prepubertal levels was observed. The GH peak following clonidine diminished significantly after 1 year. Growth hormone binding protein showed a slight increase, and IGF-I and IGFBP-3 decreased, although not significantly. Osteocalcin levels decreased significantly after 9 and 12 months of treatment, but they did not change significantly after calcitriol load, either before or after GnRHa therapy. Urinary hydroxyproline decreased significantly after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential effects of deltorphin on arginine and galanin-induced growth hormone secretion in healthy man

Recently we demonstrated the inhibitory action on Growth Hormone (GH) secretion of an opioid heptapeptide, deltorphin (DT), that is highly selective in binding δ-opioid receptors. To investigate the possible mechanism leading to the decrease in GH secretion by specific activation of δ-opioidergic pathway in man, we compared, in normal subjects, the effect of DT on GH secretion responses to two different GH secretagogues, namely arginine (ARG) and galanin (GAL). DT completely blunted the GH response to ARG, whereas it attenuated the GH response to GAL, but not at a statistically significant level. We suggest that the specific activation of δ-opioid receptors in man may exert an inhibitory influence on GH secretion principally by modulating endogenous hypothalamic somatostatin (SRIH) release.

Moderate caloric restriction alters the subcellular distribution of somatostatin mRNA and increases growth hormone pulse amplitude in aged animals.

Although growth hormone secretion decreases with age in both animals and man, its potential role in the regulation of biological aging is unknown. In a series of experiments, age-related changes in growth hormone secretory dynamics were compared in ad libitum fed and moderately calorically restricted male Brown-Norway rats. These animals exhibit an increase in both mean and maximal lifespan in response to caloric restriction. In addition, the subcellular distribution of somatostatin mRNA was compared since previous data indicated that somatostatin secretion increases with age and has an important role in the age-related decline in growth hormone pulse amplitude. In ad libitum fed animals, growth hormone secretory dynamics decreased with age and were associated with a decline in total somatostatin mRNA levels. However, analysis of somatostatin mRNA precipitating with polyribosomes revealed a significant increase with age (p < 0.05). When data were expressed as polysomal/total mRNA, levels in 25-month-old animals increased 94 and 104% compared to 6- or 16-month-old animals, respectively (p < 0.01). Growth hormone secretory dynamics decreased in young animals maintained on a moderate caloric restricted diet, but by 26 months growth hormone pulse amplitude increased and was indistinguishable from young ad libitum fed animals. In addition, the moderate caloric-restricted animals failed to exhibit the decline in total somatostatin mRNA or the increase in polyribosome-associated somatostatin mRNA characteristic of the ad libitum fed 25-month-old animals. Our results suggest that altered regulation of somatostatin mRNA at the translational level may be a contributing factor in the decrease in growth hormone secretion observed in aging animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Anabolic effect of human growth hormone: management of inherited disorders of catabolic pathways.

The effects of growth hormone treatment and dietary alanine supplementation, individually and in combination, were studied in five patients with organic acidemias. Three patients had propionic acidemia, one had 3-hydroxyisobutyric acidemia, and one had a defect in isoleucine metabolism. Two patients with propionic acidemia had decreased growth hormone secretion in response to provocative stimuli (intravenous L-arginine and oral levodopa or clonidine); the remaining subjects had sufficient growth hormone secretion. Three of four subjects in whom IGF1 was measured showed subnormal concentrations at baseline (including two with normal growth hormone secretory responses). All patients showed an increase in linear growth with growth hormone. In the four patients studied, all had a significant increase in nitrogen retention over baseline with alanine or growth hormone alone, or with the combination of growth hormone and alanine, with a much greater effect of growth hormone. Lean body mass and body fat composition tended to become normal with treatment. Protein tolerance increased, and when the patients' dietary protein intakes were increased between 20 and 60% they maintained positive nitrogen balance, without a significant increase in metabolite excretion. One patient with propionic acidemia expired during the time of the study, following a course of recurrent pancreatitis and an episode of acute basal ganglia infarction. All of the other subjects showed clinical improvement (decreased incidence of ketoacidotic episodes and decreased frequency of hospital admission and school absence) during treatment, and even the patient who expired remained metabolically stable up to and through the terminal event. We conclude that growth hormone may be of value in the management of patients with organic acidemia.

Nonparallel changes of growth hormone (GH) and insulin-like growth factor-I, insulin-like growth factor binding protein-3, and GH-binding protein, after craniospinal irradiation and chemotherapy.

We studied the GH-insulin-like growth factor-I (IGF-I) axis serially over 24-36 months in six patients with medulloblastoma who underwent surgical removal of the tumor followed by craniospinal irradiation therapy for 6 weeks and then chemotherapy for 42 weeks. Eighteen and 24 months after beginning irradiation there was a decline in the peak GH secretory response to acute stimulation with arginine/insulin hypoglycemia. Six months after irradiation and during chemotherapy there was a transient decline in IGF-I, IGF binding protein-3 (IGFBP-3), and GH-BP values (respective mean values of 56.1 +/- 9.0 ng/mL, 1.1 +/- 0.2 microgram/mL, and 7.6 +/- 3.3% of radioactivity as compared to time 0 values: 13%%o/- 15 ng/mL, 2.2 +/- 0.2 micrograms/mL, and 20.0 +/- 4.0%, P < 0.001), although provoked GH secretion was normal at this time. The IGF-I, IGFBP-3, and GH-BP returned to pretreatment ranges by 12-36 months after initiation of the study. There was also a decline in body mass index and serum protein values at 6 months, suggesting suboptimal nutrition during this period. Six months after irradiation in ligand and immunoblot analysis there was a decline in IGFBP-3 and an abnormal electrophoretic mobility of IGFBP-2 that were both normalized at 36 months. In one patient we observed a high level of IGFBP-3 proteolysis at this time. This study demonstrates that before the decrease of GH secretion in patients receiving cranial irradiation there is a transient phase of GH insensitivity that may be characteristic of the acute therapeutic phase including the chemotherapy. This partial insensitivity may explain the early growth retardation observed in these patients.