Acta Paediatrica 15. (1974)
1. szám - Kerpel-Fronius, E.-Gács, G.-Hervel, S.: Pituitary function in malnutrition
1 Acta Paediatrica Academiae Scientiarum Hungaricae, Vol. 15 (1), pp. 1—9 (1974) Pituitary function in malnutrition By E. Kerpel-Eronitjs, G. Gács, S. Kiss and S. Hervei Second Department of Paediatrics, Semmelweis University Medical School, Budapest Received July 1, 1973 Fasting blood plasma growth hormone (GH), 11-OH-steroid and free fatty acid (FFA) levels were studied in 40 cases of severe marasmus due to malabsorption syndromes, perinatal cerebral damage and congenital heart disease. In contrast to kwashiorkor, fasting GH values were mostly in the normal range. High values were found in three situations, viz. 1. in hypoproteinaemia; 2. in the diencephalic syndrome with emaciation; and 3. in three cases studied during clinically manifest hypoglycaemia. In these last patients 11-OH-steroid values were high, while FFA levels were conspicuously low, suggesting the possibility that a failure of fat mobilization might play a role in eliciting clinically manifest hypoglycaemia in marasmus. In one fourth of the marasmic cases insulin or arginine stimulation resulted in a blunted GH response. Growth retardation, as judged by height age, was similar in magnitude in both groups, in that exhibiting a blunted, and in that showing a normal GH secretory response following insulin provocation. Growth in the diencephalic cases also became with progressing marasmus — in spite of persistently acromegalic fasting GH levels — just as stunted as in any other form of chronic malnutrition. These observations suggested that growth retardation in malnutrition is caused by processes seemingly independent of the blood GH level or of the ability to release GH following stimulation. In prolonged semistarvation, phenomena possibly indicative of a decrease in pituitary function arise. Retardation in longitudinal growth, reduced basal metabolic rate, a tendency to hypoglycaemia and delayed puberty may be cited as possible examples. The concept that a state of “pseudohypophysectomy” may arise in starvation was introduced by Mulinos andPoMERANTZ [25]. These authors could prevent the atrophy of the glands under pituitary control in starved rats by the injection of pituitary extracts of fed rats. These experiments were in the following years supplemented by studies of the histological picture and later by the measurement of the growth hormone (GH) content of the gland and of the blood plasma. In starved or semistarved animals the number of eosinophile cells in the pituitary was found to be diminished [9, 31]. Later papers also described a diminished GH content of the gland [22, 34], moreover, a decrease in the GH content of blood [33, 38]. These findings are certainly in keeping with the concept of “pseudohypophysectomy”. The literature on human malnutrition is, however, more contro- Acta Paediatrica Academiae Scientiarum Eungaricae 15, 1974