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Ghrelin
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Glucagon-like peptide 1
Leptin
Neuropeptide-Y
Somatostatin
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This patient who presents with polyphagia, extreme obesity, aggressive behaviors surrounding food acquisition, and secret eating most likely has leptin deficiency. Leptin is a hormone that is produced by adipocytes and serves to regulate appetite. The circulating level of leptin is proportional to the amount of adipose stored, such that increasing levels of fat tissue function to suppress appetite. Patients who are deficient in leptin are chronically hungry and exhibit extreme behaviors surrounding the acquisition of food such as hyperphagia, fighting for food, and eating in secret. Patients will present early in childhood with these behaviors and are usually extremely obese by adolescence. Patients can be treated with exogenous leptin, which suppresses their appetite and leads to dramatic levels of weight loss. The role of leptin in normal physiology is less clear as there appears to be a ceiling effect on appetite suppression. Saeed et al. studied the levels of peripheral gastrointestinal hormones in leptin-deficient patients and found that they are not significantly different from normal controls. They conclude that additional processes that are not currently understood must be responsible for the extreme hunger seen in these patients. Incorrect Answers: Answer 1: Ghrelin is produced by P/D1 cells in the stomach and functions to regulate hunger prior to initiation of meals. Decreased levels of ghrelin would suppress appetite rather than increase appetite. Answer 2: Glucagon-like peptide 1 is produced by L cells of the intestinal epithelium and functions to increase glucose-induced insulin secretion. While it also has a small effect in promoting satiety, deficiency of this hormone would not cause extreme hunger as is seen with leptin deficiency. Answer 4: Neuropeptide-Y is produced by neurons of the sympathetic nervous system and functions to increase appetite. A deficiency of this hormone would result in decreased appetite rather than hyperphagia. Answer 5: Somatostatin is produced by D cells of the gastrointestinal mucosa as well as delta cells of the endocrine pancreas. This hormone leads to decreased pancreatic fluid production, decreased gastric secretion, and decreased insulin release. A deficiency would result in increased activity of the gastrointestinal system rather than extreme hunger. Bullet Summary: Leptin is a hormone produced by adipose tissue and functions to decrease appetite.
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