GROWTH-HORMONE AFTER ABDOMINAL-SURGERY ATTENUATED FOREARM GLUTAMINE, ALANINE, 3-METHYLHISTIDINE, AND TOTAL AMINO-ACID EFFLUX IN PATIENTS RECEIVING TOTAL PARENTERAL-NUTRITION

Objective The study clarified the effects of growth.hormone treatment on forearm amino acid efflux in patients with full nutritional support after gastrointestinal surgery. Summary Background Data Growth hormon e attenuates net nitrogen loss after surgical trauma. An increase in n et protein synthesis has been described, whereas the results regarding protein breakdown have been conflicting. Methods Elective patients un dergoing abdominal surgery were double blindly randomized to treatment with recombinant human growth hormone (GH, n = 9) 24 IU or placebo (P L, n = 10) the first 5 postoperative days. All received parenteral nut rition (nitrogen = 5.7 +/- .1 g/mw, energy = 1018 +/- 12 kcal/M2 (125 +/- .7% of BMR) and epidural analgesia. Amino acid plasma levels and f orearm fluxes were measured. Results The second postoperative day, gro wth hormone abolished forearm efflux of total amino acid nitrogen (GH: 170 +/- 117, PL: -785 +/- 192 nmol/100 mL/min, p = .0007) due to redu ced losses of both essential and nonessential amino acids. Glutamine r elease was abolished (13 +/- 15 vs. -137 +/- 43 nmol/100 mL/min, p = . 007) and alanine release attenuated (-61 +/- 17 vs. -211 +/- 51 nmol/1 00 mL/min, p = .01). 3-Methyl-histidine release was attenuated (-.20 /- .11 vs. -.62 +/- .09 nmol/100 mL/min, p = .04). Growth hormone also induced decreased venous plasma amino acid levels. Conclusions When g iven after gastrointestinal surgery in patients treated with total par enteral nutrition, growth hormone treatment abolished glutamine, 3-met hylhistidine, and total amino acid nitrogen loss from forearm tissue. Alanine loss from forearm tissue was attenuated.