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Sleep
Hypothalamus
GHRH
+
DIRECT EFFECTS
Liver: gluconeogenesis and glycogenolysis
Stress
Adipose: lipolysis
Muscle: glycogenolysis and inhibition of glycogen synthesis
Somatostatin
Ghrelin
(mainly from
the stomach)
Pituitary
GH
Liver
IGF-I
Figure 5.5 Summary of the regulation and effects of growth hormone (GH). Some of the anabolic effects of GH are mediated by local
production of IGF-I acting in an autocrine or paracrine manner. In addition to the feedback loops shown, glucagon and free fatty acids
decrease GH secretion by increasing somatostatin release. GHRH, growth hormone-releasing hormone; IGF-I, insulin-like growth
factor I.
lean
body mass. The converse effects are seen with
decline in GH secretion with ageing, features
of
which can be partially reversed by GH
administration. As well as GH, IGF-I concentration also
declines with advancing age. Accordingly, ageand
abcd
sex-matched
normal
ranges
are
necessary
for
the
appropriate interpretation of serum IGF-I
assays.
Without these details, there is a risk of
incorrectly
diagnosing overactivity or underactivity of
the
GHIGF-I axis.
Sodium and water homeostasis
free
9
008
12
16
20
24
Clock time
04
08
increase
in
serum
GH. Although negative feedback has been
proposed
for IGF-I (see Figure 5.5), the GH axis
lacks
a
single
end-organ secreting a hormone with a
clear
negative
feedback role. Contrast this with cortisol
from
the
adrenal
cortex,
which
suppresses
corticotrophicreleasing hormone (CRH) and ACTH
secretion.
axis
GH release is pulsatile (Figure 5.6):
andom serum GH is a poor marker of
clinical
R
GH status
series
E
of serum measurements is
needed
Circulating
IGF-I
concentration
is
relatively
constant:
andom serum IGF-I is a useful marker
of
R clinical GH status
The
phenotypic
appearance
of
excessive
bone
growth differs depending on whether
the patient
Normal
1
12
(a)
0
0
2
4
Hours
Glucose
(b)
Normal
6
3
0
Partial
deficiency
0
2
Hours
Insulin
GH (ng/mL)