Development of acromegaly in a patient with anorexia nervosa: Pathogenetic and diagnostic implications

Abstract

Anorexia nervosa (AN) is a psychosomatic disorder characterized by an alteration in body image, resulting in eating abnormalities that lead to malnutrition associated with secondary endocrinological disturbances. AN is associated with high levels of GH and low levels of IGF-I, suggestive of a nutritionally acquired lack of GH action or GH resistance and of an unbalanced hypothalamic GH neuroregulation with GHRH prevalence on SS tone. In this clinical report, we describe the development of acromegaly in a patient affected by AN and we discuss pathogenetic and diagnostic implications.

Acromegaly Accompanied by Turner Syndrome with 47,XXX/45,X/46,XX Mosaicism

“…In addition to some genetic events in neoplastic transformation, increased GHRH secretion has a possible role for somatotrope tumorigenesis. A case report of acromegaly in a patient with anorexia nervosa, which causes functional GH insensitivity, is meaningful and helpful to consider somatotrope tumorigenesis in GH insensitivity syndrome (29). We believe that the present case is highly suggestive to elucidate the mechanism of GH/IGF-I action in Turner syndrome.…”

Coexisting diseases modifying each other’s presentation - lack of growth failure in Turner syndrome due to the associated pituitary gigantism

“…Increased need of peripheral tissues for larger amount of IGF-1 could link GH/IGF-1 resistance and GHRH hypersecretion. Similar mechanism could explain the occurrence of acromegaly in patient with anorexia nervosa, a psychosomatic disorder characterized by functional GH resistance 19 .…”

“…Pituitary function is under tight hypothalamic control, mediated by the effects of releasing and inhibiting hormones. It has been proposed that pituitary tumors are derived from an intrinsic pituitary cell defect leading to monoclonal expansion of a single transformed cell 19 . Hypothalamic hormones may have an important role in promoting the growth of already transformed cell clones and expansion of small adenomas into large tumors.…”

Biochemical Evaluation of Patients with Active Acromegaly and Type 2 Diabetes Mellitus: Efficacy and Safety of the Galanin Test

“…The galanin test has been proposed as a useful diagnostic tool in acromegaly in selected clinical settings, such as in the presence of anorexia nervosa in which a preexisting disorder of the GH/IGF-1 axis is demonstrated [27]. In the present study, we assessed the galanin test in acromegalic patients with type 2 diabetes.…”

“…In vitro studies suggest that galanin may directly inhibit GH secretion in human GH-secreting adenoma cells interacting with specific pituitary receptors [25, 26]. It can be alternatively hypothesized that galanin may act by somatostatin receptors on tumor pituitary cells [27]. Since the inhibitory effects of galanin on GH secretion were demonstrated in adenomas defined as non-responders to octreotide, one could argue that galanin may interact with somatostatin receptors other than type 2 and type 5 [26].…”