Posttraumatic hormonal environment during total parenteral nutrition.
Hormonal responses to major trauma trigger a cascade of metabolic adjustments leading to catabolism and substrate mobilization. Energy deficit and energy surfeit have profound effects on hormone levels. To characterize the course of changes in regulatory hormone levels after multiple injury, we measured the plasma levels of eight hormones, once within 48-60 h after injury in the fasting state and then daily for 5 days during the administration of total parenteral nutrition in 10 hypermetabolic, highly catabolic, and severely injured adult patients. Acute deficiency in anabolic insulinlike growth factor 1 (IGF-1) and growth hormone levels and elevated levels of counterregulatory stress hormones and insulin were seen as a result of trauma. Provision of nutrition on the 1st day has no effect on IGF-1 and cortisol levels. However, growth hormone levels are raised to normal, and the nitrogen balance is improved. Over the next 4 days, there were no appreciable changes in these parameters. The persistent low levels of IGF-1 reflect the altered nutrition status of the patients, as characterized by the continued negative nitrogen balance and elevated cortisol levels in the early posttrauma period. Anabolic IGF-1 and insulin levels showed significant negative correlation with the catabolic indicators 3-methylhistidine and catecholamine excretion. The results suggest that IGF-1 is regulated by nutritional intake independently of growth hormone and may be a better nutrition indicator.
Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ 80513.
M
M
Jeevanandam
N J
NJ
Holaday
S R
SR
Petersen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002096:C-Peptide / Q000378:metabolism; D004837:Epinephrine / Q000378:metabolism; D005260:Female; D005934:Glucagon / Q000097:blood; D013006:Growth Hormone / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008762:Methylhistidines / Q000652:urine; D009104:Multiple Trauma / Q000097:blood* / Q000628:therapy*; D009638:Norepinephrine / Q000378:metabolism; D010289:Parenteral Nutrition, Total
D002096:C-Peptide; D006728:Hormones; D008762:Methylhistidines; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005934:Glucagon; C028118:3-methylhistidine; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine