The endocrine response to acute ghrelin administration is blunted in patients with anorexia nervosa, a ghrelin hypersecretory state

F Broglio, L Gianotti, S Destefanis, S Fassino, G Abbate Daga, V Mondelli, F Lanfranco, C Gottero, C Gauna, L Hofland, A J Van der Lely, E Ghigo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

106 Citations (Scopus)


OBJECTIVE Ghrelin, a gastric-derived natural ligand of the GH secretagogue (GHS)-receptor (GHS-R), strongly stimulates GH secretion but also possesses other neuroendocrine actions, stimulates food intake and modulates the endocrine pancreas and energy homeostasis. Ghrelin secretion is negatively modulated by food intake. Similarly, glucose and also insulin probably exert an inhibitory effect on ghrelin secretion. Fasting ghrelin levels are reduced in obesity, elevated in anorexia nervosa and restored by weight recovery. The chronic elevation of circulating ghrelin levels in anorexia suggested the hypothesis of an alteration of the sensitivity to the orexigenic action of ghrelin in this condition. The aim of this study was to define the endocrine actions of ghrelin in patients with anorexia nervosa.

DESIGN We enrolled nine women with anorexia nervosa of restricter type [AN; age (mean +/- SEM) 24.2 +/- 1.8 years; body mass index (BMI) 14.7 +/- 0.4 kg/m(2)] and seven normal young women in their early follicular phase as control group (NW; age 30.6 +/- 3.1 years; BMI 20.3 +/- 0.5 kg/m(2)).

MEASUREMENTS In all the subjects we studied the GH, PRL, ACTH, cortisol, insulin and glucose responses to acute ghrelin administration (1.0 mug/kg as i.v. bolus). The GH response to GHRH (1.0 mug/kg as i.v. bolus) and basal ghrelin and IGF-I levels were also evaluated in all the subjects.

RESULTS Basal morning ghrelin and GH levels in AN (643.6 +/- 21.3 ng/l and 10.4 +/- 0.5 mug/l, respectively) were higher (P <0.05) than in NW (233.5 +/- 14.2 ng/l and 0.7 +/- 0.7 mug/l, respectively). However, IGF-I levels in AN (145.3 +/- 10.9 mug/l) were lower (P <0.05) than in NW (325.4 +/- 12.6 mug/l). The GH response to GHRH in AN was higher (P <0.05) than that in NW, but in AN the GH response to ghrelin was lower (P <0.05) than that in NW. In AN and NW ghrelin also induced similar increases (P <0.05) in PRL, ACTH and cortisol levels. Ghrelin administration was followed by significant increase in glucose levels in NW (P <0.05) but not in AN.

CONCLUSIONS This study demonstrates that anorexia nervosa, a clinical condition of ghrelin hypersecretion, shows a specific reduction in the GH response to ghrelin, despite the hyper-responsiveness to GHRH administration. The impaired GH response to ghrelin in anorexia nervosa agrees with previous evidence of blunted GH response to synthetic GH secretagogues and could reflect desensitization of the GHS receptor induced by the chronic elevation of ghrelin levels in this pathological state.

Original languageEnglish
Pages (from-to)592-599
Number of pages8
JournalClinical endocrinology
Issue number5
Publication statusPublished - May 2004


  • Analysis of Variance
  • Hydrocortisone
  • Human Growth Hormone
  • Humans
  • Insulin-Like Growth Factor I
  • Adrenocorticotropic Hormone
  • Insulin
  • Blood Glucose
  • Ghrelin
  • Prolactin
  • Peptide Hormones
  • Adult
  • Case-Control Studies
  • Anorexia Nervosa
  • Growth Hormone-Releasing Hormone
  • Statistics, Nonparametric
  • Female

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