ENDOCRINE RESPONSE IN MARASMUS AND KWASHIORKOR: CORTISOL, GH, IGF-1 AND THE REHABILITATION PROCESS

Abstract

Protein-energy malnutrition (PEM) in childhood constitutes a serious public health concern, particularly in contexts marked by socioeconomic vulnerability, and is associated with high rates of morbidity and mortality. Among its most severe manifestations are marasmus and kwashiorkor, distinct clinical conditions that reflect different patterns of metabolic adaptation to prolonged deprivation of energy and protein. Beyond a mere nutritional deficit, PEM involves complex hormonal alterations, notably the activation of the hypothalamic–pituitary–adrenal axis and changes in the somatotropic axis, which establish a predominantly catabolic metabolic state. Thus, the present study seeks to address the following guiding question: To what extent do adaptive hormonal responses to nutritional deprivation determine not only organism survival but also the distinct clinical expressions observed in marasmus and kwashiorkor? Using a hypothetical-deductive methodological approach, through bibliographic research and analysis of clinical and pathophysiological studies, special attention is given to the endocrine alterations involved in severe malnutrition. This research aims to examine, in light of scientific evidence, the modulatory role of hormonal axes in the clinical differentiation of these conditions, emphasizing the importance of an integrated understanding of endocrine-metabolic mechanisms for improving therapeutic strategies and the clinical management of childhood malnutrition.