title: Central ghrelin production does not substantially contribute to systemic ghrelin concentrations: a study in two subjects with active acromegaly.
abstract: BACKGROUND
  In an animal model of acromegaly (PEPCK-hGH transgenic mice), low systemic levels of ghrelin have been observed compared with normal mice. We hypothesized that systemic circulating ghrelin levels are also decreased in humans with active acromegaly and that the contribution of central ghrelin production to systemic ghrelin levels is minimal.
  
  
  OBJECTIVE
  The aim of the present study was to investigate, in two subjects with active acromegaly, whether there are differences between systemic ghrelin levels and ghrelin concentrations in the petrosal sinus.
  
  
  METHODS
  We measured systemic and central ghrelin levels in these two acromegalic patients by bilateral simultaneous inferior petrosal sinus sampling. Central and systemic blood samples were drawn before and 1, 5, 10, 15 and 20 min after stimulation with GH-releasing hormone (GHRH). Ghrelin was measured with a commercially available radioimmunoassay.
  
  
  RESULTS
  In one acromegalic subject, the baseline systemic and central ghrelin levels were within the same range as in two non-acromegalic obese subjects. No gradient could be observed between central and systemic ghrelin concentrations. Stimulation with GHRH did not change the ghrelin concentrations in this patient. In the other acromegalic subject, the systemic ghrelin levels were also in the same range as in two non-acromegalic obese subjects. However, in this subject, baseline ghrelin concentrations in the right inferior petrosal vein were considerably lower than the systemic ghrelin concentrations, indicating a peripheral over central gradient. Administration of GHRH induced a significant rise in central ghrelin concentrations in the right inferior petrosal vein. Ghrelin levels in the left inferior petrosal vein and systemic ghrelin levels were in the normal range and GHRH stimulation did not change these concentrations.
  
  
  CONCLUSIONS
  The absence of a central over peripheral ghrelin gradient in these two acromegalics indicated that circulating ghrelin is mainly produced peripherally. Circulating systemic ghrelin levels were not decreased in these two subjects with active acromegaly.
authors.affiliation: Department of Internal Medicine, Section of Endocrinology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Fanny M
authors.initials: FM
authors.lastname: van der Toorn
authors.forename: Joop A M J L
authors.initials: JA
authors.lastname: Janssen
authors.forename: Wouter W
authors.initials: WW
authors.lastname: de Herder
authors.forename: Fabio
authors.initials: F
authors.lastname: Broglio
authors.forename: Ezio
authors.initials: E
authors.lastname: Ghigo
authors.forename: Aart J
authors.initials: AJ
authors.lastname: van der Lely
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D015992:Body Mass Index; D003346:Corticotropin-Releasing Hormone; D054439:Ghrelin; D013007:Growth Hormone-Releasing Hormone; D006801:Humans; D007700:Kinetics; D008297:Male; D036361:Peptide Hormones; D010455:Peptides / Q000032:analysis / Q000097:blood* / Q000378:metabolism*; D017591:Petrosal Sinus Sampling; D010902:Pituitary Gland / Q000378:metabolism
chemical_list: D054439:Ghrelin; D036361:Peptide Hormones; D010455:Peptides; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D013007:Growth Hormone-Releasing Hormone