1. During the initial stages of the development of hypoalbuminaemia, with concentrations between 25 and 30 g/l, fasting serum cortisol and growth hormone values remained normal. Corresponding fasting serum insulin concentrations were, however, significantly above normal. During the same period, called phase B, valine concentrations were moderately low but alanine concentrations were raised.
2. In more severe hypoalbuminaemia, culminating in kwashiorkor, a marked switch in hormonal balance occurred. Insulin concentrations fell to subnormal levels whereas cortisol became raised. Eventually growth hormone concentrations also increased rapidly to values similar to those found in acromegaly. By this time, phase C, alanine concentrations as well as those of valine were falling to very low levels.
3. The possible causes of these changes in hormonal balance, their role in the development of the distorted fasting serum amino acid pattern and their consequent effect on serum albumin synthesis and the appearance of clinical kwashiorkor are discussed.
4. Information is also presented on the differences between these components in kwashiorkor and marasmus. Attempts have been made to rationalize apparent inconsistencies in the literature.