Treatment with GH and IGF-1 in critical illness.
Trauma, sepsis, and surgery are associated with global hypercatabolism and a negative nitrogen balance. When critical illness is prolonged the relentless loss of lean tissue becomes functionally important. Protein catabolism in the critically ill patient is associated with complex changes in the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis. Many small clinical studies indicate that treatment with recombinant human (rh) GH would be a safe and effective means of limiting the deleterious effects of the catabolic response. Unexpectedly, however, two large prospective randomized controlled trials (PRCTs) demonstrated that administration of rhGH to long-stay critically ill adults increases morbidity and mortality. Some progress has been made in understanding the mechanisms underlying this observation.
Teng Chung
Teng
T
Department of Endocrinology, 5th Floor, King George V Building, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
Hinds
Charles J
CJ
D002908:Chronic Disease / Q000188:drug therapy; D016638:Critical Illness / Q000628:therapy*; D013006:Growth Hormone / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000494:pharmacology / Q000627:therapeutic use*; D011506:Proteins / Q000378:metabolism*; D013312:Stress, Physiological / Q000188:drug therapy*
D011506:Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone