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The hypothalamic pituitary adrenal function in mal nutrition a comparison between psycho somatic diseases treated with fasting therapy and anorexia nervosa






Folia Endocrinologica Japonica 55(6): 739-760

The hypothalamic pituitary adrenal function in mal nutrition a comparison between psycho somatic diseases treated with fasting therapy and anorexia nervosa

The hypothalamic-pituitary-adrenal axis was investigated in 33 patients with various psychosomatic diseases treated with fasting therapy for 11 days, and a comparative study was made between this group and13 young women with anorexia nervosa. The administration of dexamethasone failed to suppress cortisol [F] levels to a normal range in 14 of 33 patients during fasting. The normal circadian rhythm of plasma F was abolished in 9 of 21 patients during fasting. Plasma F concentrations were significantly elevated at any given time of the day, especially in the dexamethasone nonsuppressive patients. The excretion of urinary 17-OHCS [17-hydroxycorticosteroids] and 17-KS [17-kelosteroids] in the 24-h samples after the oral administration of metopirone was significantly higher in fasting patients as compared with non-fasting patients. The response of plasma ACTH to metopirone showed a nonsignificant increase. The circadian rhythm of ACTH responsiveness to metopirone administration was normal in patients during fasting. The plasma F response to .beta.1-24 ACTH 0.25 mg i.m. was significantly higher in fasting than in non-fasting patients. The basal urinary 17-OHCS and 17-KS in the 24-h sample displayed a biphasic fluctuation with the peaks at 3 and 6 days after the initiation of fasting. The F metabolic clearance rate in fasting patients was prolonged as compared with that in non-fasting patients. After refeeding, pituitary adrenal functions returned to normal in all patients. Anorexia nervosa patients, non-suppressive to dexamethasone, demonstrated elevated plasma F levels and normal responses to metopirone and ACTH, with a decreased excretion of urinary 17-OHCS and 17-KS. High levels of plasma F in both fasting and anorexia nervosa were caused by abnormalities of the negative feedback mechanism and prolongation of F metabolic clearance rate. Patients exposed to fasting revealed an adrenocortical hyperfunction.

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Accession: 006689071



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