Energy metabolism and hormonal profile in children with edematous protein-calorie malnutrition.

Modifications in energy metabolism and endocrine homeostasis (plasma insulin and growth hormone values, glucose and free fatty acid levels, serum thyroxine and TSH, free thyroxine index, and urinary catecholamines) were investigated in eight children with edematous protein-calorie malnutrition. Caloric expenditure was low at admission and correlated linearly with increased caloric intake throughout the study. The hormonal changes at admission were characterized by a negligible insulin response to intravenous arginine or glucose and by markedly elevated growth hormone levels which were neither increased by arginine nor suppressed by intravenous glucose. Serum thyroxine values were low, but free thyroxine index and serum TSH levels were within normal limits. At admission to the study, 24-hour urinary excretion of dopamine and norepinephrine was relatively reduced in relation to the excretion of epinephrine. All these modifications were corrected at time of the recovery study. It is suggested that in edematous protein-calorie malnutrition, insulin acts as the primary regulator of peripheral fuel release and that the high, nonsuppressible growth hormone levels may form part of an important homeostatic mechanism to provide substrates for brain metabolism via lipolysis.