Basal and pulsatile secretion of growth hormone (GH) is increased, with a peripheral resistance to its effects. Serum GH levels are elevated in 60% of patients, particularly in the most severe cases. This is due to decreased feedback from lowered serum concentrations of insulin-like growth factor 1 (IGF 1) and to increased serum levels of ghrelin. Growth hormone levels do not rise normally after L-dopa or insulin hypoglycemia, but there may be an unexpected rise in GH blood levels after stimulation with thyrotrophin-releasing hormone.
Ghrelin is a recently discovered polypeptide secreted by the stomach that increases in circulation with weight loss. Ghrelin is an activating ligand for the GH secretagogue receptor in the hypothalamus. With starvation and weight loss, the increased serum levels of ghrelin increase the release of GH and hunger. Individuals with anorexia nervosa have high serum levels of ghrelin that return to normal with normalization of body weight.
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