Are the metabolic alterations associated with critical illness related to the hormonal environment?
The hormonal environment has a direct effect on mediating the catabolic response to critical illness. Administering hormones to normal volunteers simulated many, but not all, of the alterations observed in patients following injury or severe injection. The administration of an inflammatory agent, etiocholanolone, initiated a variety of acute phase responses and interacted with hormonally mediated changes to elicit a variety of responses commonly observed in critically ill patients. Further studies have manipulated the hormone environment in critically ill patients by administering anabolic factors or blocking catabolic hormone elaboration. These investigations have demonstrated a marked attenuation of many of the catabolic responses to critical illness. Such manipulations give some insight into the potential for patient care in the future, where catabolic responses could be successfully blunted, and anabolic hormones administered so as to prevent the marked wasting and tissue disruption that heretofore have commonly been associated with catabolic disorders.
Wilmore
D W
DW
Harvard Medical School, Boston, Massachusetts 02115, USA.