In obesity the reduced growth hormone (GH) responses to several provocative stimuli including growth hormone-releasing hormone (GHRH) indicate a diminished somatotroph responsiveness but do not distinguish between primary pituitary and hypothalamic pathogenesis. However, it has been shown that the cholinergic system positively influences GH secretion likely by modulating somatostatin release in a negative way. Thus, the effect of cholinergic activity enhancement by pyridostigmine (PD), an acetylcholinesterase inhibitor, on both basal and GHRH-induced GH secretion was studied in 14 obese subjects (eight adults and six children). Eighteen nonobese subjects (seven adults and 11 children) were studied as controls. In obese subjects the GHRH-induced GH increase was lower than in controls (peak, mean ± SEM, adults, 9.2 ± 2.7 v 16.8 ± 5.7 ng/mL; children, 8.0 ± 0.8 v 20.3 ± 4.6 ng/mL) attaining statistical significance only in children group ( P < .02). The PD-induced GH response in the two obese groups was similar to that observed in relative controls (adults, 5.3 ± 1.0 v 7.4 ± 1.7 ng/mL; children, 9.6 ± 1.6 v 13.3 ± 1.4 ng/mL). PD clearly potentiated the GH response to GHRH in obese subjects, both adults ( P < .05 v GHRH alone) and children ( P < .0005 v GHRH alone). However, the GH response to PD + GHRH was significantly reduced in obese subjects compared with controls (adults, 18.1 ± 2.2 v 42.7 ± 10.7 ng/mL, P < .05; children, 28.3 ± 4.5 v 58.2 ± 7.7 ng/mL, P < .01). In conclusion, PD is able to potentiate the blunted GH response to GHRH in obese adults and children, inducing a GH increase similar to that observed after GHRH alone in normal subjects. This finding suggests that an alteration of somatostatinergic tone could be involved in the reduced GH secretion in obesity. However, considering that in obese subjects the PD + GHRH-induced GH response is lower than that observed in normals, these data suggest a coexisting primary pituitary impairment.
Read full abstract