METABOLIC EFFECTS OF ADJUVANT RECOMBINANT HUMAN GROWTH-HORMONE IN PATIENTS WITH CONTINUING SEPSIS RECEIVING PARENTERAL-NUTRITION

Background: Adjuvant growth hormone is advocated for treating the cata bolism of prolonged sepsis not corrected by parenteral nutrition alone . Methods: An open study was performed in which eight patients whose p ostabsorptive resting energy expenditure was persistently elevated by a mean of 19%, as a result of continuing sepsis were randomized to rec eive 0.03 or 0.06 mg/kg recombinant human growth hormone (rhGH) each e vening for 7 days adjuvant to total parenteral nutrition. Plasma conce ntrations of growth hormone, insulin, insulin-like growth factors 1 an d 2 (IGF-1 and -2) and their binding proteins IGFBP-1 and -3 were meas ured before and after rhGH, and their relationship with rates of whole -body protein turnover was determined in the morning in the postabsorp tive state by using L-[1-C-13]leucine. Results and Conclusions: Before rhGH, the patients were hyperinsulinemic (mean, 44.4 mU/L) but had gr owth hormone levels within the normal range (<10 mU/L). After the seve nth dose of rhGH, nocturnal growth hormone concentrations rose to a me an of 35.3 +/- 26.1 and 61.3 +/- 21.05 mU/L for the low and higher dos e groups, respectively. Morning IGF-1 concentrations showed a small in crease during treatment, rising from a mean of 241.3 +/- 99.0 to 301.7 +/- 167.3 ng/mL for the low-dose group and from 214.5 +/- 74.6 to 294 .1 +/- 116.9 ng/mL for the higher-dose group. IGF-S increased slightly by 89 +/- 39 and 75 +/- 49 ng/mL for the low and higher doses, respec tively. IGFBP-1 and -3 and insulin did not change. The balance between nitrogen input and urinary urea nitrogen increased after rhGH by a me an of 5.3 g/d with no differences between the two dosage groups (4.74 +/- 1.56 g/d for the higher dose, 5.94 +/- 3.70 g/d for the lower). No significant changes were observed in whole-body protein turnover afte r a 1-week course of rhGH.