EFFECTS OF HUMAN GROWTH-HORMONE IN CRITICALLY ILL NONSEPTIC PATIENTS - RESULTS FROM A PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Objectives: To study the effects of growth hormone administration on i nsulin-like growth factor I concentration, nitrogen balance, and fuel utilization, and to study its safety in critically ill nonseptic patie nts, Design: Prospective, randomized, placebo-controlled trial, Settin g: Medical intensive care unit of a university hospital. Patients: Eig hteen critically ill nonseptic patients were studied for 8 days after admission, Interventions: Growth hormone (0.1 mg/kg/day) or placebo wa s administered as a continuous intravenous infusion on the second, thi rd, and fourth days after admission, The study period was 8 days, Meas urements and Main Results: Plasma hormone concentrations were measured every 6 hrs and average daily values were calculated, The 24-hr urina ry nitrogen and 3-methylhistidine excretion were measured, Indirect ca lorimetry was used to calculate fuel utilization, Insulinlike growth f actor I concentrations increased in the treatment group from subnormal to normal values and remained increased despite discontinuation of gr owth hormone treatment (p = .02). Nitrogen balance differed between th e groups upon admission: growth hormone group (3.9 +/- 4.1 g/day) vs, controls (13.8 +/- 5.4 g/day), but improved with growth hormone, This finding appeared independent of the imbalance between the groups, The 3-methylhistidine excretion was not different between the groups and d id not change during growth hormone administration. Free fatty acids a nd glycerol concentrations increased during growth hormone treatment, but calculated fuel utilization did not change, During growth hormone treatment, insulin concentrations increased, due to the increased admi nistration of insulin necessary for glycemic control, Side effects oth er than hyperglycemia were not observed, Conclusions: Growth hormone a dministration in a heterogeneous group of critically ill nonseptic pat ients resulted in normalization of insulin-like growth factor I levels , even after cessation of growth hormone treatment, Nitrogen balance i mproved, but this change was transient, Hence, growth hormone affects nitrogen balance, probably partly independent of insulin-like growth f actor I.