Thyroid hormonal studies in normal and severely malnourished infants and small children

The measurement of thyroxine-bindung prealbumin (TBPA) in protein-calorie malnutrition by two different techniques leads to the recognition of an unexpected discrepancy. Whereas TBPA plasma levels as measured by immunodiffusion are markedly decreased to 29.3% of the normal, those recorded by maximal binding capacity (TBPAcap) are characterized by a wide dispersion. In the control group, the ratio between TBPAcap and TBPA plasma level is 9.1. In the malnourished group on admission, the same ratio is 30.0. The possibility of a qualitative effect in the tetrameric TBPA structure, with the binding of additional thyroxine (T4) molecules on the secondary binding sites, has been investigated. This hypothesis has been discarded by Scatchard plot studies. The normal 1:1 molar ratio between TBPA and T4 is unaffected in protein-deficient patients. Discrepant results obtained for TBPAcap and TBPA levels appear to be the consequence of low plasma protein levels, leading to an artifact in the electrophoretic method.

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“…in this paper could also explain the high values for TBPAc recorded in the only other published study on %hiding proteins in PCM (30).…”

Section: Discussionsupporting

confidence: 71%

Discrepancy between the Measurement of Thyroxine‐Binding Prealbumin Plasma Level and Binding Capacity in Protein‐Calorie Malnutrition

Ingenbleek

Nayer

Visscher

1975

Eur J Clin Investigation

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“…Therecent demonstration of a correlation between the low BMR of marasmus and reduced concentrations of muscle ATP and creatinine phosphate suggests a tissue rather than a thyroid cause for low BMR (Parra et al, 1973a) as originally suggested by Montgomery (1962). Similarly, diminution in protein bound iodine (Godard & Lemarchand-Beraud, 1973), butanol extractable iodine (Beas et af., 1966) and total thyroxine (T4) (Godard & Lemarchand-Beraud, 1973;Graham et al, 1973) could be interpreted as reflecting low thyroxine binding globulin (Ingenbleek et al, 1974;Graham et al, 1973) and prealbumin (Ingenbleek et af., 1972), as T4 is largely protein bound. Recent measurements of plasma free T4 showed normal or elevated results in kwashiorkor, and normal or low levels in marasmus (Graham et af., 1973).…”

Section: P I T U I T a R Y -T H Y R O I D F U N C T I O Nmentioning

confidence: 99%

“…More recently, direct measurements of plasma TSH have become available (Hall et af., 1970). In South American marasmus (Godard & Lemarchand-Beraud, 1973;Graham et al, 1973) and in malnourished Ugandan children (Harland & Parkin, 1972) low plasma levels of immunoassayable TSH have been reported, whereas others have found normal or elevated TSH values in marasmic kwashiorkor (Pimstone et af., 1973; Graham et af., 1973), with an exaggerated or sustained response to thyrotrophin releasing hormone (TRH) in a proportion of patients . It has been suggested that the high plasmaTSH might reflect impaired catabolism rather than increased secretion (Godard, 1974).…”

Section: P I T U I T a R Y -T H Y R O I D F U N C T I O Nmentioning

confidence: 99%

“…However, impaired catabolism should in turn reduce pituitary secretion of TSH in order to maintain normal levels if TSH is normally suppressible, which appears likely, as exogenous triiodothyronine (T3) suppressed TSH . Nevertheless normal or elevated free T4 in the face of normal or elevated TSH has been reported (Graham et al, 1973) and raises the question of whether T4 is exerting appropriate feedback control of TSH. Measurements of free T3 and of peripheral deiodination of T4 to T3 are not available to settle these issues.…”

Section: P I T U I T a R Y -T H Y R O I D F U N C T I O Nmentioning

confidence: 99%

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Endocrine Function in Protein‐calorie Malnutrition

Pimstone

1976

Clinical Endocrinology

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Undernutrition is widespread. In spite of the research and development being directed towards its prevention and alleviation, the weight of numbers as well as social, cultural, economic and technological considerations make eradication unlikely in the foreseeable future. Ironically, malnutrition is often endemic in areas in which sophisticated medical facilities exist; the problem clearly goes deeper than the mere availability of medical care. But this curious juxtaposition of poverty and medical sophistication has allowed numerous workers to study endocrine function in protein-calorie malnutrition (PCM). As hormones such as glucagon, insulin, growth hormone and cortisol are concerned with the efficient utilization of food, storage and expenditure of energy, and the latter three hormones with synthesis of body protein, it has been suggested that adaptive changes based on alterations in hormone secretion of function might allow for better survival of the threatened individual (Monckeberg, 1968); this conclusion, however, must be regarded as speculative at present; an alternative explanation might be that they are non-specific consequences of severe nutritional deprivation.This review is not primarily concerned with hormonal changes in prolonged fasting, nor will it refer in great depth to animal models of malnutrition which, while they have the advantage of producing more precise quantitation of the deficit, may not always be relevant to the situation in man. For infantile malnutrition is not merely the deprivation of proteins and calories ; it is inevitably associated with variable degrees of vitamin and mineral deficiency, intercurrent infection and electrolyte changes. To what extent hormonal changes are attributable to malnutrition as opposed to associated phenomena is not always apparent, but these might be very relevant in considering the pathogenesis of endocrine dysfunction in the human as opposed to the experimental context.

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“…Nine normal subjects were studied twice, at different ages; six only once. The reasons for admission, diet, physical findings, growth pattern, and routine laboratory investigations have been described (9,13).…”

Section: Subjects Normal Control Subjectsmentioning

confidence: 99%

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

et al. 1976

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Thyroid hormonal studies in normal and severely malnourished infants and small children

Cited by 23 publications

References 18 publications

Discrepancy between the Measurement of Thyroxine‐Binding Prealbumin Plasma Level and Binding Capacity in Protein‐Calorie Malnutrition

Discrepancy between the Measurement of Thyroxine‐Binding Prealbumin Plasma Level and Binding Capacity in Protein‐Calorie Malnutrition

Endocrine Function in Protein‐calorie Malnutrition

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

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