Growth hormone in infant malnutrition: the arginine test in marasmus and kwashiorkor

Abstract

I. Experiments in children and in animals seem to demonstrate that in marasmic malnutrition there is a reduction in the secretion of growth hormone. T o study this problem the fasting, resting plasma concentrations of growth hormone were determined, before, and 45 and 60 min after, stimulation with an intravenous dose of arginine, in six infants with marasmus, in six infants with kwashiorkor and in five normal infants. 2.The values of plasma growth hormone (4.1 k 0 . 9 7 ng/ml) in marasmic infants were significantly (P < o.001) lower than those of the controls (7.8 k 2.6 nglml), and responded little to stimulation with arginine (5.1 and 5.8 ng/ml at 45 and 60 min respectively), in contrast to those in the control group, which rose to 16.4 and 14.6 ng/ml. In children with kwashiorkor the values were very variable, but generally high, and showed little response (25.6 13.3 before and 25.0 f 17.6 and 14.2 f 5.3 ng/ml at 45 and 60 min after stimulation respectively).3. These results demonstrate that the responses of the hypophysis to deprivation of calories and protein (marasmus) and to protein deprivation (kwashiorkor) are different: in marasmus there is a progressive adaptation, with low secretion and poor reaction to stimulation, whereas in kwashiorkor the process is acute with high basal values of plasma growth hormone.

Metabolic and Hormonal Responses to a Protein-Glucose Meal in Normal Infants and in Marasmus and Marasmic Kwashiorkor

“…After partial rehabilitation, fasting G H levels were moderately lower, but not significantly so. This is compatible with the reports of others who studied partially treated infants (4,11,12). The finding of a G H response to the protein-glucose meal in some, but not all partially rehabilitated infants is in accord with data of Godard and Zahnd (1 1, 12), but not that of Beas et al (4).…”

“…The earliest determinations of fasting G H in untreated kwashiorkor found it to be consistently elevated (40); this has been confirmed (4,12,14,26,31,32,39). Elevated levels were not suppressed by induced hyperglycemia (31,38,39) and were not further raised by intravenous arginine (4,14), but dropped promptly after meals containing protein (39,40) or a mixture of essential amino acids (32).…”

“…Elevated levels were not suppressed by induced hyperglycemia (31,38,39) and were not further raised by intravenous arginine (4,14), but dropped promptly after meals containing protein (39,40) or a mixture of essential amino acids (32). Significant inverse correlations between plasma G H and serum albumin levels (7, 26) suggest a causal relationship, but artificially raising serum albumin levels did not have a predictable effect on G H levels (5, 7), suggesting that they are independent manifestations of protein deficiency.…”

“…Although it was recognized that impaired absorption would influence the results, and that the responses observed might not be maximal, we felt that they would be more representative of responses taking place when such infants are realimented than those to induced hyper-and hypoglycemia or to amino acid infusions (2,4,8,11,12,14,31,39,41). Because of the paucity of reported normal values in infants of different ages, and because control samples handled in the sample manner as the study samples would be more meaningful, we evaluated healthy infants selected to match the study cases in age and body size.…”

“…The evidence suggests that in untreated marasmus, plasma G H is already elevated, or responds appropriately to different stimuli. During the first few weeks of dietary therapy, the responsiveness of G H may be blunted (4,14,34).…”