Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit

Ziegler, Thomas R.; Young, Lorraine S.; Ferrari-Baliviera, Elisabetta; Demling, Robert H.; Wilmore, Douglas W.

doi:10.1177/0148607190014006574

Cited by 151 publications

(33 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although safety results from the use of GH at the present dosage of 0.3 mg/kg/week in paediatric practice in the USA are reassuringly good, the use of GH in adults poses a different problem, with abnormal carbohydrate metabolism developing in elderly people, in obese patients, in postoperative states and in burn patients, even though doses are relatively smaller than those administered to children [27, 28, 29, 30]. …”

Section: Gh Therapy and Carbohydrate Metabolismmentioning

confidence: 99%

Metabolic Consequences of Growth Hormone Treatment in Paediatric Practice

Saenger¹

2000

Horm Res Paediatr

View full text Add to dashboard Cite

No metabolic side-effects of clinical significance have been reported during a 5-year study of growth hormone (GH) therapy in children with GH deficiency, Turner syndrome, idiopathic short stature or chronic renal insufficiency. In particular, insulin levels increase but remain within the normal range, as do glucose and haemoglobin A_1c. A recent study showed that the effects of growth on insulin sensitivity in prepubertal children with idiopathic short stature represent the changes in carbohydrate tolerance observed during normal adolescence. Thus, GH treatment may lead to prolongation of the physiological state of insulin resistance observed in normal puberty. Insulin levels during the fasting state and 2 h after a standard glucose load showed no further rise after the first 3 years of continuous GH therapy. The hyperinsulinaemia observed during GH therapy may, therefore, amplify the anabolic effects of insulin on protein metabolism during puberty.

show abstract

Section: Gh Therapy and Carbohydrate Metabolismmentioning

confidence: 99%

Metabolic Consequences of Growth Hormone Treatment in Paediatric Practice

Saenger¹

2000

Horm Res Paediatr

View full text Add to dashboard Cite

show abstract

“…Insulin added to total parenteral nutrition (TPN) regimens and intramuscular GH administration result in reduced postoperative protein loss, preservation of body composition, and increased hand grip strength [25,26]. Much more work is required, however, before this protocol can be used routinely for major surgery [27].…”

Section: Management During the Postoperative Phasementioning

confidence: 99%

Metabolic basis for the management of patients undergoing major surgery

1993

View full text Add to dashboard Cite

After reviewing our current knowledge of the metabolic response to major abdominal surgery, we present two new studies in which we have followed the changes in body composition, physiologic function, and psychological function for up to 1 year after major surgery. In the first study, 46 patients had changes in body composition, physiologic function, and psychological function measured perioperatively and again at intervals up to 1 year. There was an average loss of weight of 3000 grams Imaximum at 2 weeks/, and the tissue composition of this weight loss was composed of 1400 grams fat. 600 grams protein, and 1000 grams water. Normal body composition had returned to normal in most patients by 6 months. In the second study of 84 patients, deficits of skeletal muscle function and fatigue were found to be greatest at postoperative day 7. Most patients were back to preoperative levels of muscle function and fatigue 30 days after surgery, and nearly all had normal values 90 days after surgery. Based on these studies we outline our management program for the metabolic care of patients undergoing major abdominal surgery.Over many years surgeons have been interested in the early metabolic responses in patients undergoing major surgery particularly while the patients are still in the hospital, but it is only recently that long-term changes in metabolism, body composition. physiology, and psychological function have been studied over the weeks and months following surgery. Here we look at what is known about the metabolic changes brought about by the surgical procedure and show how these changes may persist for weeks and in some cases months before the patient is restored to full health. On this basis we set out a management program for the metabolic care of patients undergoing uncomplicated major elective surgery. Metabolic Response to SurgeryCuthbertson [1] divided the metabolic response to injury into an early ebb phase, characterized by hypovolemia and subsequent sympathetic and adrenal response, and a later flow phase, during which the injured patient loses protein at an accelerated rate. The duration of the flow phase depends on the severity of the injury, and it is gradually replaced by a convalescent anabolic phase, during which the protein and energy stores lost in the early postinjury period are repleted (Table 1). Ebb PhaseThe ebb phase is largely a result of hypovolemia, and it lasts until circulating blood volume is restored. The pale, clammy, tachycardiac patient visited by the surgeon soon after surgery is in the ebb phase. Hume and Egdahl [2] demonstrated the importance of the brain to the early endocrine response to injury. They disconnected an anesthetized animal's limb from its body, leaving only the sciatic nerve and femoral vessels. When they measured the level of corticosteroids in adrenal venous blood in response to a burn to the isolated limb they found an immediate rise; when the sciatic nerve was divided, this response did not occur. These same workers showed subsequently that the early hormone res...

show abstract

“…hGH has anabolic effects, which result in an increase in lean body mass (6,10,14). In contrast to other anabolic agents, hGH also has anticatabolic actions mediated via the direct effects on cells, the release of insulin-like growth factor type 1, and the protein-sparing effects of lipid oxidation (2,5,10,19,21). Given the clinical benefits of r-hGH in patients with AIDS-related wasting, our findings that r-hGH has no effect on viral replication or on the antiretroviral activity of currently available ARVs are reassuring.…”

mentioning

confidence: 61%

Lack of Effect of Recombinant Human Growth Hormone on the In Vitro Activities of Antiretroviral Drugs against Human Immunodeficiency Virus Type 1

Wainberg

Brenner

Daar

et al. 2004

Antimicrob Agents Chemother

View full text Add to dashboard Cite

We studied the effects of recombinant human growth hormone (r-hGH) on human immunodeficiency virus type 1 replication by growing both wild-type and drug-resistant variants of virus in the presence of various concentrations of eight different antiretroviral drugs. r-hGH had no significant effect on either viral replication or the 50% inhibitory concentrations of these compounds.Although highly active antiretroviral therapy (HAART) has led to declines in the rates of mortality and AIDS-related opportunistic infections in the developed world, there remains a need to prevent the loss of lean body tissue (wasting) in patients with human immunodeficiency virus (HIV) infection and AIDS (12,16). Human growth hormone (hGH) increases lean body mass and muscle nitrogen retention and thus represents a potential approach to the treatment of AIDS-related wasting (9, 13). In randomized double-blind placebo-controlled trials performed in the pre-HAART and HAART eras, recombinant hGH (r-hGH) was shown to increase total body weight and lean body mass and to decrease body fat content (9,15,17,20). These changes are associated with improvements in physical performance and quality of life (15,17,20). Although optimization of nutritional status and exercise may also provide benefits in many cases, treatment with hGH is an excellent option in patients with severe wasting.However, concern exists that r-hGH might stimulate viral replication or inhibit the activities of antiretroviral drugs (ARVs) (4), since one early study actually found that r-hGH increased the levels of p24 antigen released from peripheral blood mononuclear cells (PBMCs) in tissue culture at concentrations of 50 or 100 ng/ml, but not at concentrations of 1, 5, 10, or 250 ng/ml (7). Importantly, r-hGH did not affect the antiviral activity of zidovudine in that study. Subsequent experiments (E. Daar, unpublished data) showed that r-hGH did not increase the level of HIV replication in PBMCs at concentrations of up to 250 ng/ml and had no effect on the antiviral activities of a variety of ARVs used in the pre-HAART era (zidovudine, didanosine, zalcitabine, and stavudine). The present experiments confirm and extend these findings through the use of currently approved ARVs in each of the three major drug classes. Viral isolates. We used two wild-type (wt) and five drugresistant clinical isolates of HIV type 1 (HIV-1), the genotypes of which are shown in Table 1. The wt isolates were from patients who had not received therapy. The concentrations of all approved ARVs that inhibit viral replication by 50% (IC 50 s) for the isolates were confirmed to be the same as those for other wt isolates, and the phenotypes of the isolates were the same as those of other wt isolates. Genotyping for the detection of mutations associated with drug resistance was performed by sequencing analysis with the Tru-Gene system (Bayer Diagnostics Inc., Toronto, Ontario, Canada). The resistant isolates were from patients who had been extensively treated with antiviral agents.In vitro studies. IC 50 s ...

show abstract

Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit

Cited by 151 publications

References 24 publications

Metabolic Consequences of Growth Hormone Treatment in Paediatric Practice

Metabolic Consequences of Growth Hormone Treatment in Paediatric Practice

Metabolic basis for the management of patients undergoing major surgery

Lack of Effect of Recombinant Human Growth Hormone on the In Vitro Activities of Antiretroviral Drugs against Human Immunodeficiency Virus Type 1

Contact Info

Product

Resources

About