Secretion of growth hormone (GH) is excessive in acromegaly, but also in a number of other pathological states such as anorexia nervosa, insulin-dependent diabetes mellitus (IDDM), liver cirrhosis, depression, renal failure and GH-insensitivity syndrome. Abnormalities in the neuroendocrine control of GH secretion and/or a state of insensitivity to GH contribute to hypersecretion of GH in these states, with the possible exception of acromegaly, which appears to be a primary pituitary disease. GH hypersecretion may also occur in neonates or adolescents with tall stature, thus reflecting particular physiological or paraphysiological conditions. In the cohort of brain neurotransmitters, catecholamines and acetylcholine reportedly play a major role in the control of neurosecretory GH-releasing hormone (GHRH) and somatostatin (SS)-producing neurons, and hence GH secretion. Activation of alpha 2-adrenoceptors or of muscarinic cholinergic receptors in the hypothalamus stimulates GH release, probably through stimulation of GHRH and inhibition of SS release, respectively. Activation of dopamine receptors likewise stimulates GH release, while activation of beta-receptors inhibits GH release through stimulation of hypothalamic SS function. This review discusses the involvement of brain catecholamines and acetylcholine in GH hypersecretory states, including anorexia nervosa, acromegaly, IDDM, liver cirrhosis, depression, renal failure and GH insensitivity syndrome, with a view to providing a fuller understanding of their pathophysiology and, whenever possible, diagnostic and therapeutic implications.
Aim: To determine the systodiastolic variations in the integrated backscatter (IBS) signal of the myocardium in patients with anorexia nervosa. Methods: 25 young women (aged 22.4 ± 4.3 y) with overt anorexia nervosa, compared with 25 age‐matched thin and 25 age‐matched control women with body mass index >20 kg m−2, underwent either conventional two‐dimensional echocardiography or analysis of IBS cyclic variations. Results: Compared with thin and control subjects, anorectic patients showed reduced left ventricular mass (LVM: 82.9 ± 17.1 vs 119.9 ± 13.8 and vs 126.12 ± 16.4 g, p < 0.0001; LVM indexed 21.4 ± 3.3 vs 29.4 ± 2.5 and vs 31.2 ± 3.1 g m−2.7, p < 0.0001), and IBS cyclic variations (septum: –0.49 ± 2.18 vs 6.86 ± 1.3 and vs 6.61 ± 1.74 dB, p < 0.0001; posterior wall: 2.77 ± 2.12 vs 7.15 ± 2.12 and vs 7.48 ± 2.23 dB, p < 0.01).
Conclusion: Anorexia nervosa is associated with a significant reduction in the cyclic variation in IBS, which is also related to left ventricular hypotrophy. Ultrasonic tissue characterization could give an objective approach for the detection of myocardial structural properties and represent a preclinical index of myocardial dysfunction in anorexia nervosa.
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