Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury

R. Y.Declan Fleming, Randi L. Rutan, Farouk Jahoor, Robert E. Barrow, Robert R. Wolfe, David N. Herndon

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Severe burn injury elicits the release of catabolic hormones that contribute to negative nitrogen balance, protein wasting, and impaired wound healing. Previous studies have shown that burn patients receiving recombinant human growth hormone (rhGH) therapy have an increase in the rate of skin donor site healing and a shorter hospital stay. The mechanism by which rhGH exerts its effects, however, is not clearly understood. This study examines the effects of rhGH on circulating levels of catabolic hormones and nonesterified fatty acids in pediatric burn patients. Patients with >40% total body surface area burn were randomly assigned to receive placebo (n = 8) or 0.2 mg/kg/day rhGH (n = 6) throughout their hospitalization. All patients had early morning blood samples assessed for catecholamines (CAT), cortisol, insulin, glucagon, and free fatty acid (FFA) levels during a period of hypermetabolism. No differences could be demonstrated in age, burn size, postburn day of evaluation, resting energy expenditure per kilogram, respiratory rate, heart rate, respiratory quotient, serum cortisol, and serum glucose between placebo- and rhGH-treated patients. The rhGH-treated group did show a significant elevation (p < 0.05) in insulin-like growth factor-1 (55.9 ± 14.5 vs. 168 ± 23.7 mU/mL), total catecholamines (1, 817 ± 177 vs. 1, 117 ± 137 pg/mL), norepinephrine (1, 257 ± 121 vs. 867 ± 113 pg/mL), epinephrine (385 ± 175 vs. 147 ± 36 pg/mL), insulin (32.8 ± 3.3 vs. 25.0 ± 3.0 mU/mL), glucagon (215 ± 18 vs. 158 ± 22 pg/mL), and free fatty acids (0.74 ± 0.01 vs. 0.59 ± 0.04 mEq/L) compared with the placebo group (data expressed as mean ± SE). Data indicate that insulin resistance and resultant hyperinsulinemia caused by rhGH therapy may lead to an increase in catecholamines, glucagon, and FFAs. The anabolic effects of rhGH, insulin, and IGF-1 appear to attenuate detrimental “stress catabolism” and may be beneficial in the care of critical burn injuries.

Original languageEnglish (US)
Pages (from-to)698-703
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume32
Issue number6
DOIs
StatePublished - Jun 1992

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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