Golden N H, Kreitzer P, Jacobson M S, Chasalow F I, Schebendach J, Freedman S M, Shenker I R
Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York.
J Pediatr. 1994 Oct;125(4):655-60. doi: 10.1016/s0022-3476(94)70030-3.
Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3. In contrast, serum GHBP (p < 0.001), IGF-1 (p < 0.001), and IGFBP-3 (p < 0.01) were significantly lower in group 1 than in group 3. Serum GHBP and IGFBP-3 levels were positively correlated with body mass index. Serum GHBP levels were low in patients in all five pubertal stages and even in those shown to have adequate GH secretion. In group 2 (after refeeding) the serum IGF-1 concentration increased significantly and GHBP and IGFBP-3 returned to normal. We conclude that patients with anorexia nervosa have diminished GH action resulting in decreased secretion of IGF-1. The positive correlation with body mass index and the reversibility with refeeding suggest that these changes are secondary to malnutrition. Altered GH function that occurs during the years of active growth can explain the growth retardation seen in anorexia nervosa.
在青春期患神经性厌食症的女性会出现线性生长停滞，并伴有低水平的胰岛素样生长因子I（IGF-1）。为了研究神经性厌食症青少年生长发育迟缓的病理生理学，我们测量了三组患者的基础生长激素（GH）、生长激素结合蛋白（GHBP）、IGF-1和胰岛素样生长因子结合蛋白-3（IGFBP-3）：（1）28名近期住院的患神经性厌食症的女性青少年；（2）同一组中的23名患者在部分体重恢复后；（3）28名年龄、性别和青春期阶段相匹配的健康对照者。第1组的空腹GH水平与第3组相比无显著差异。相比之下，第1组的血清GHBP（p < 0.001）、IGF-1（p < 0.001）和IGFBP-3（p < 0.01）显著低于第3组。血清GHBP和IGFBP-3水平与体重指数呈正相关。所有五个青春期阶段患者的血清GHBP水平均较低，即使是那些显示有足够GH分泌的患者也是如此。在第2组（重新进食后），血清IGF-1浓度显著升高，GHBP和IGFBP-3恢复正常。我们得出结论，神经性厌食症患者的GH作用减弱，导致IGF-1分泌减少。与体重指数的正相关以及重新进食后的可逆性表明，这些变化是营养不良的继发结果。活跃生长期间发生的GH功能改变可以解释神经性厌食症中出现的生长发育迟缓。
