title: Serum ghrelin concentrations are increased in children with growth hormone insensitivity and decrease during long-term insulinlike growth factor-I treatment.
abstract: BACKGROUND
  Ghrelin increases food intake, body weight, and growth hormone (GH) secretion. Serum concentrations of ghrelin are low in obese hyperinsulinemic persons, are reduced by infusion of insulin into normal-weight subjects, and are increased in underweight hypoinsulinemic patients with anorexia nervosa. Laron syndrome is an autosomal recessive disorder of GH insensitivity that results in decreased insulinlike growth factor-I (IGF-I) synthesis and growth failure. These patients have elevated GH levels, excess adipose tissue, and are insulin resistant. Because IGF-I has insulinlike actions and patients with GH insensitivity syndrome (GHIS) exhibit excess adiposity, we sought to determine whether ghrelin levels were elevated in these patients and potentially regulated by IGF-I replacement.
  
  
  METHODS
  Thirteen children with GHIS and 20 normal control children matched for age, sex, and body mass index underwent complete physical examination and a fasting blood draw at baseline. The GHIS subjects then underwent follow-up fasting blood draws during therapy with human recombinant IGF-I (80-120 mug/kg, given subcutaneously twice daily). Fasting glucose, insulin, and IGF-I concentrations were measured at the time of collection. Fasting total ghrelin levels were measured on stored serum samples.
  
  
  RESULTS
  The GHIS subjects had 2-fold higher fasting ghrelin levels (2926 +/- 1869 pg/mL) compared with the normal control children (1492 +/- 493 pg/mL; P = 0.009), and mean ghrelin values were reduced 56% during 6.4 +/- 0.2 years of IGF-I replacement (P < 0.05).
  
  
  CONCLUSIONS
  Growth hormone resistance and low IGF-I levels are associated with elevated ghrelin levels, which may potentiate GH secretion and adiposity in these children. Suppression of ghrelin during IGF-I treatment suggests a novel mechanism potentially regulating ghrelin levels.
authors.affiliation: Department of Pediatrics, Division of Endocrinology, The University of North Carolina at Chapel Hill, NC, USA. uckuna@yahoo.com
authors.forename: Aysin
authors.initials: A
authors.lastname: Uckun-Kitapci
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Haqq
authors.forename: Jonathan Q
authors.initials: JQ
authors.lastname: Purnell
authors.forename: Kenneth
authors.initials: K
authors.lastname: Newcomb
authors.forename: Hakan
authors.initials: H
authors.lastname: Gulkesen
authors.forename: Louis E
authors.initials: LE
authors.lastname: Underwood
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D054439:Ghrelin / Q000097:blood* / Q000187:drug effects; D006130:Growth Disorders; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use*; D008297:Male; D011994:Recombinant Proteins; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D054439:Ghrelin; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I