Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children

David Herndon, Charles D. Voigt, Karel D. Capek, Paul Wurzer, Ashley Guillory, Andrea Kline, Clark R. Andersen, Gordon L. Klein, Ronald G. Tompkins, Oscar Suman, Celeste Finnerty, Walter Meyer, Linda Sousse

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND:: The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years after injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1-, β2-adrenoceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit. METHODS:: In this prospective, randomized study of 612 burned children [52%?±?1% of total body surface area burned, ages 0.5–14 years (boys); ages 0.5–12 years (girls)], we compared controls to the individual administration of these drugs, and the combined administration of oxandrolone and propranolol at the same doses, for 1 year after burn. Data were recorded at discharge, 6 months, and 1 and 2 years after injury. RESULTS:: Combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days (P = 0.0125 vs control) and increased growth rate by 1.7?cm/yr (P = 0.0024 vs control). CONCLUSIONS:: Combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients. The present study is registered at clinicaltrials.gov: NCT00675714 and NCT00239668.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jul 18 2016

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Oxandrolone
Propranolol
Growth
Pediatrics
Testosterone
Body Surface Area
Wounds and Injuries
Burns
Bone Density
Adrenergic Receptors
Energy Metabolism
Catecholamines
Adrenal Cortex Hormones
Prospective Studies
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Surgery

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Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children. / Herndon, David; Voigt, Charles D.; Capek, Karel D.; Wurzer, Paul; Guillory, Ashley; Kline, Andrea; Andersen, Clark R.; Klein, Gordon L.; Tompkins, Ronald G.; Suman, Oscar; Finnerty, Celeste; Meyer, Walter; Sousse, Linda.

In: Annals of Surgery, 18.07.2016.

Research output: Contribution to journalArticle

Herndon, David ; Voigt, Charles D. ; Capek, Karel D. ; Wurzer, Paul ; Guillory, Ashley ; Kline, Andrea ; Andersen, Clark R. ; Klein, Gordon L. ; Tompkins, Ronald G. ; Suman, Oscar ; Finnerty, Celeste ; Meyer, Walter ; Sousse, Linda. / Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children. In: Annals of Surgery. 2016.
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AU - Voigt, Charles D.

AU - Capek, Karel D.

AU - Wurzer, Paul

AU - Guillory, Ashley

AU - Kline, Andrea

AU - Andersen, Clark R.

AU - Klein, Gordon L.

AU - Tompkins, Ronald G.

AU - Suman, Oscar

AU - Finnerty, Celeste

AU - Meyer, Walter

AU - Sousse, Linda

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N2 - BACKGROUND:: The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years after injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1-, β2-adrenoceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit. METHODS:: In this prospective, randomized study of 612 burned children [52%?±?1% of total body surface area burned, ages 0.5–14 years (boys); ages 0.5–12 years (girls)], we compared controls to the individual administration of these drugs, and the combined administration of oxandrolone and propranolol at the same doses, for 1 year after burn. Data were recorded at discharge, 6 months, and 1 and 2 years after injury. RESULTS:: Combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days (P = 0.0125 vs control) and increased growth rate by 1.7?cm/yr (P = 0.0024 vs control). CONCLUSIONS:: Combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients. The present study is registered at clinicaltrials.gov: NCT00675714 and NCT00239668.

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