Endogenous anabolic hormones and hypermetabolism: effect of trauma and gender differences.
OBJECTIVE
Protein degradation, negative nitrogen balance and compromised structure of essential organs have been associated with resistance and decreased production of anabolic hormones. In turn, increased levels of anabolic hormones are associated with improved survival. The aims of the present study were to determine the pattern of anabolic hormones, resting energy expenditure and cytokines in severely thermally injured pediatric patients and to compare these parameters in female and male patients.


METHODS
Sixty-five children (1 to 16 years of age) sustaining a severe thermal injury (> or =40% TBSA) were included into the study. Patients were further divided into females (n = 22) and males (n = 43). Patient demographics, nutritional support, incidence of sepsis, inhalation injury, and mortality were noted. Resting energy expenditure was measured during hospital course by indirect calorimetry. Blood was drawn 0, 10, 20, and 40 days postburn and serum insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-1 and -3 (IGFBP-1, and -3), growth hormone, insulin, and cytokines were measured.


RESULTS
There were no significant differences between females and males for demographics, nutritional intake, or concomitant injuries. In both groups, endogenous anabolic agents were drastically decreased by 3- to 5-fold up to 40 days posttrauma. Females had significantly higher levels of IGF-I, IGFBP-3, growth hormone, and insulin when compared with males, P < 0.05. Increased levels of anabolic hormones were associated with decreased stay on the ICU (females 36 +/- 22 days versus males 53+/- 39 days), decreased serum IL-1beta and TNF-alpha as well as resting energy expenditure, P < 0.05.


CONCLUSIONS
Data indicate that despite adequate nutritional support, severe thermal injury leads to decreased anabolic hormones over a prolonged period of time. Female patients had significantly increased levels of anabolic hormones, which are associated with decreased proinflammatory mediators and hypermetabolism, leading to a significant shorter ICU stay compared with male patients.
Jeschke
Marc G
MG
Shriners Hospital for Children and Department of Surgery, University Texas Medical Branch, Galveston, Texas 77550, USA. majeschk@utmb.edu
Barrow
Robert E
RE
Mlcak
Ron P
RP
Herndon
David N
DN
D000293:Adolescent; D002056:Burns / Q000378:metabolism*; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000378:metabolism*; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D012737:Sex Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D016207:Cytokines; D007328:Insulin; D018969:Insulin-Like Growth Factor Binding Proteins; D014409:Tumor Necrosis Factor-alpha; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone