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Karl M. Pirke, Manfred M. Fichter, Raimar Lund, and Peter Doerr


The 24-h sleep-wake pattern of plasma LH was studied in 18 patients with severe weight loss. Sixteen patients had anorexia nervosa, one suffered from schizophrenia and one had a gastric ulcer. The age of the patients ranged from 13 to 31 years. Seventeen women and one boy participated in the study. Their weight ranged from 51 to 73 % of the ideal body weight (IBW) at the first 24-h study which was at one week after admission to the hospital. Blood was taken through an indwelling venous catheter every 30 min. The patients' weight increased under behavioural therapy and they were re-studied when they had gained approximately 10 % IBW and again prior to release from the psychiatric ward. The LH patterns were classified as infantile, pubertal or adult. All patients except for two had an iniantile pattern at the first study. Except for the two patients who had no anorexia nervosa, all developed a pubertal and/or an adult pattern. All patients whose weight was below 69 % IBW had an infantile LH pattern. Adult patterns were only seen when the body weight was greater than 80 % IBW. The increase of the average 24-h LH values was slower the older the patients were and the longer they had been anorectic.

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B Otto, U Cuntz, E Fruehauf, R Wawarta, C Folwaczny, RL Riepl, ML Heiman, P Lehnert, M Fichter, and M Tschop

OBJECTIVE: Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS: Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS: Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION: We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.