One-year intranasal GHRP-2 treatment improves body weight and hypoglycemia in severe anorexia nervosa

Patients with severe, long-term anorexia nervosa often struggle with chronic emaciation even after psychological recovery from the fear of eating. This is frequently due to severe digestive tract dysfunction, including delayed gastric emptying, incurable constipation, and resulting symptoms like vomiting, sub-ileus, and hypoglycemia. These physical barriers prevent an increase in food intake and weight gain, creating a cycle of malnutrition. Growth Hormone Releasing Peptide-2 (GHRP-2) is a potent agonist for the ghrelin receptor (GHSR) and is known to stimulate hunger and food intake. While used diagnostically in Japan, its therapeutic potential for the severe physical symptoms of chronic anorexia nervosa has been unexplored, presenting a novel avenue for treatment.

This case study details the treatment of a single female patient with a 20-year history of severe anorexia nervosa. The patient was unable to gain weight despite psychological improvements due to severe digestive dysfunction. The intervention involved administering GHRP-2 intranasally before every meal for one year. The primary goals were to determine if this regimen could increase food intake, body weight, and alleviate gastrointestinal symptoms. The patient's progress, including body weight, subjective feelings of hunger and satiety, physical and mental activities, and any side effects, were monitored throughout the treatment period.

Intranasal GHRP-2 administration yielded significant improvements. The patient reported an increased feeling of hunger and was able to increase her food intake. Concurrently, she experienced decreased early satiety. The treatment effectively improved her recurrent hypoglycemia. Over a period of 14 months from the start of the intervention, the patient's body weight gradually but substantially increased.

The patient's body weight increased by 6.7 kg, rising from 21.1 kg to 27.8 kg.

This weight gain was accompanied by marked functional improvements, including reduced fatigability, increased muscle strength, and enhanced physical and mental activities. Importantly, no obvious side effects were observed throughout the long-term administration of GHRP-2, demonstrating its potential safety and tolerability in this context.