Ghrelin and the GH secretagogue receptors (GHS-R) are expressed in several peripheral tissues, including adrenal glands. The hypothalamic-pituitaryadrenal axis of patients with 21-hydroxylase deficiency (21OH-D) can be only partially balanced after treatment. This could interfere with the ghrelin/GH/ IGF1 axis, contributing to the poor auxological outcome of these patients. We studied the possible short term effects of corticosteroids administration on the ghrelin/GH/IGF1 and the CRF/ACTH/adrenal axes in CAH patients, examining thirty-seven 21OH-D patients (17 M, 20 F; 13 SW, 11 SV, 13 NC forms). The patients avoided for one day the evening doses of glico- and mineralo-corticoids; the morning after, two blood samples were drawn (8:00 a. m. and 10:30-11:00 a.m.), the first immediately before and the second after an evening+morning dose of therapy. In both samples glycaemia, ghrelin, GH, IGF1, CRF, ACTH, cortisol, D4-androstenedione (D4-A), 17OH-progesterone (17OHP), insulin, plasma renin activity (PRA) were assayed. As expected, the pre/post treatment evaluation showed a statistically significant rise in cortisol and a fall in ACTH, 17OHP and D4-A levels; the same pattern of cortisol was shown by ghrelin, glycaemia and PRA, while IGF1 levels decreased; no significant differences were found for Insulin, CRF and GH levels. Analysis in a multiple regression model, showed that plasma ghrelin changes were mainly due to changes of D4-A (pre and post therapy; F=6.465, P=0.0136) and at a minor extent to changes of GH (only post therapy; F=4.447, P=0.044). Ghrelin showed to be influenced from acute corticosteroid therapy as were the other hormones involved in the hypothalamic-pituitary-adrenal and GH/IGF1 axes; interestingly, a similar ghrelin/D4-A negative correlation was found from Gambineri et al. in a group of obese women with polycystic ovary syndrome; a potential negative effect on ghrelin levels can be hypothesized for the CAH patients whose androgens could not be well controlled with treatment.
A. Balsamo, S. Forti, M. Bal, M. Gennari, R. Di Iasio, S. Gualandi, et al. (2005). Relationships between ghrelin, hypothalamic-pituitary-adrenal- and GH/IGF1 axes in patients treated for congenital adrenal hyperplasia.
Relationships between ghrelin, hypothalamic-pituitary-adrenal- and GH/IGF1 axes in patients treated for congenital adrenal hyperplasia
BALSAMO, ANTONIO;FORTI, SARA;BAL, MILVA ORQUIDEA;GENNARI, MONIA;GUALANDI, STEFANO;ELLERI, DANIELA;CICOGNANI, ALESSANDRO
2005
Abstract
Ghrelin and the GH secretagogue receptors (GHS-R) are expressed in several peripheral tissues, including adrenal glands. The hypothalamic-pituitaryadrenal axis of patients with 21-hydroxylase deficiency (21OH-D) can be only partially balanced after treatment. This could interfere with the ghrelin/GH/ IGF1 axis, contributing to the poor auxological outcome of these patients. We studied the possible short term effects of corticosteroids administration on the ghrelin/GH/IGF1 and the CRF/ACTH/adrenal axes in CAH patients, examining thirty-seven 21OH-D patients (17 M, 20 F; 13 SW, 11 SV, 13 NC forms). The patients avoided for one day the evening doses of glico- and mineralo-corticoids; the morning after, two blood samples were drawn (8:00 a. m. and 10:30-11:00 a.m.), the first immediately before and the second after an evening+morning dose of therapy. In both samples glycaemia, ghrelin, GH, IGF1, CRF, ACTH, cortisol, D4-androstenedione (D4-A), 17OH-progesterone (17OHP), insulin, plasma renin activity (PRA) were assayed. As expected, the pre/post treatment evaluation showed a statistically significant rise in cortisol and a fall in ACTH, 17OHP and D4-A levels; the same pattern of cortisol was shown by ghrelin, glycaemia and PRA, while IGF1 levels decreased; no significant differences were found for Insulin, CRF and GH levels. Analysis in a multiple regression model, showed that plasma ghrelin changes were mainly due to changes of D4-A (pre and post therapy; F=6.465, P=0.0136) and at a minor extent to changes of GH (only post therapy; F=4.447, P=0.044). Ghrelin showed to be influenced from acute corticosteroid therapy as were the other hormones involved in the hypothalamic-pituitary-adrenal and GH/IGF1 axes; interestingly, a similar ghrelin/D4-A negative correlation was found from Gambineri et al. in a group of obese women with polycystic ovary syndrome; a potential negative effect on ghrelin levels can be hypothesized for the CAH patients whose androgens could not be well controlled with treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
