Growth Hormone: The Visible Difference in Burn Care

  • Michael J. Muller
  • Thomas C. Rutan
  • David N. Herndon
Conference paper
Part of the Serono Symposia USA book series (SERONOSYMP)

Abstract

The response to a large burn is characterized by increased basal metabolic rate, elevated core temperature, hyperdynamic circulation, protein catabolism, futile substrate cycling, marked lipolysis, loss of lean body mass, increased susceptibility to infection, and poor wound healing. This is known as the stress response, and the nervous system plays a major role in its pathophysiology (1-14). The limbic system is activated by fear, emotion, and thalamic relay of peripheral nocioceptive stimuli (15). Inflammatory mediators and various cytokines, such as bacterial endotoxin, interleukin-1, and tumor necrosis factor a, stimulate the hypothalamus directly (16-20). They increase the thermoregulatbry set point and alter endocrine function (21-23).

Keywords

Growth Hormone Human Growth Hormone Growth Hormone Treatment Recombinant Human Growth Hormone Protein Anabolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Soroff HS, Rozin RR, Mooty J, et al. Role of human growth hormone in the response to trauma: metabolic effects following burns. Ann Surg 1967; 166:739–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Volenec FJ. Metabolic profiles of thermal trauma. Ann Surg 1979;190:694–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Herndon DN, Curreri PW, Abston S, et al. Treatment of burns. Curr Probl Surg 1987;2:347–97.CrossRefGoogle Scholar
  4. 4.
    Herndon DN, Wilmore DW, Mason AD. Development and analysis of a small animal model simulating the postburn hypermetabolic response. J Surg Res 1978:394–403.Google Scholar
  5. 5.
    Wilmore DW, Long JM, Mason AD Jr, et al. Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 1974;180: 653–66.PubMedCrossRefGoogle Scholar
  6. 6.
    Alexander JW. Nutrition and infection—a new perspective on an old problem. Arch Surg 1986;121:966–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolfe RR, Jahoor F, Hartl WH. Protein and amino acid metabolism after injury. Diabetes Metab Rev 1989;5:149–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Shaw JHF, Wolfe RR. An integrated analysis of glucose, fat, and protein metabolism in severely traumatized patients. Studies in the basal state and the response to total parenteral nutrition. Ann Surg 1989;209:63–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Wolfe RR. Nutrition and metabolism in burns. In: Critical care. Fullerton, CA: Society of Critical Care Medicine, 1986;7:19–63.Google Scholar
  10. 10.
    Wolfe RR, Herndon DN, Peters EJ, et al. Regulation of lipolysis in severely burned children. Ann Surg 1987;206:214–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Wolfe RR, Durkot MJ, Allsop JR, Burke JF. Glucose metabolism in severely burned patients. Metabolism 1979;1031–9.Google Scholar
  12. 12.
    Jahoor F, Peters EJ, Wolfe RR. The relationship between gluconeogenic substrate supply and glucose production in humans. Am J Physiol 1990; 258:E288–96.PubMedGoogle Scholar
  13. 13.
    Aulick LH, Wilmore DW. Increased peripheral amino acid release following burn injury. Surgery 1979;85:560–5.PubMedGoogle Scholar
  14. 14.
    Jahoor F, Desai M, Herndon DN, et al. Dynamics of the protein metabolism response to burn injury. Metabolism 1988;37:330–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Hume DM, Egdahl RH. The importance of the brain in the endocrine response to injury. Ann Surg 1959;150:697–712.PubMedCrossRefGoogle Scholar
  16. 16.
    Egdahl RH. The differential response of the adrenal cortex and medulla to bacterial endotoxin. J Clin Invest 1959;38:1120–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Kupper TS, Deitch EA, Baker CC, et al. The human burn wound as a primary source of interleukin-1 activity. Surgery 1986;100:409–15.PubMedGoogle Scholar
  18. 18.
    Bentler B, Cerami A. Cachectin: more than a tumor necrosis factor. N Engl J Med 1987;316:379–85.CrossRefGoogle Scholar
  19. 19.
    Dinarello CA, et al. Tumor necrosis factor (cachectin) is an endogenous pyrogen and induces production of interleukin-1. J Exp Med 1986;163: 1433–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Michie HR, Wilmore DW. Sepsis, signals, and surgical sequelae: a hypothesis. Arch Surg 1990;125:531–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Dinarello CA, Conno JG, Wolff SM. New concepts on pathogenesis of fever. Rev Infect Dis 1988;10:168–89.PubMedCrossRefGoogle Scholar
  22. 22.
    Morimoto A, Murakami N, Nakamori T, et al. Multiple control of fever production in the central nervous system of rabbits. J Physiol 1988;397: 269–80.PubMedGoogle Scholar
  23. 23.
    Wilmore DW, Orcutt TW, Mason AD Jr, et al. Alterations in hypothalamic function following thermal injury. J Trauma 1975;15:697–703.PubMedCrossRefGoogle Scholar
  24. 24.
    Rutan TC, Herndon DN, Van Osten T, Abston S. Metabolic rate alterations in early excision and grafting versus conservative treatment. J Trauma 1986; 26:140–2.PubMedCrossRefGoogle Scholar
  25. 25.
    Herndon DN, Barrow RE, Rutan RL. A comparison of conservative versus early excision therapies in severely burned patients. Ann Surg 1989;209: 547–53.PubMedCrossRefGoogle Scholar
  26. 26.
    Goran MI, Broemeling L, Herndon DN, et al. Estimating energy requirements in burned children: a new approach derived from measurements of resting energy expenditure. Am J Clin Nutr 1991;54:35–40.PubMedGoogle Scholar
  27. 27.
    Wolfe RR, Herndon DN, Jahoor F, et al. Effect of severe burn injury on substrate cycling by glucose and fatty acids. N Engl J Med 1987;317:403–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolfe RR, Klein S, Herndon DN, et al. Substrate cycling in thermogenesis and amplification of net substrate flux in human volunteers and burned patients. J Trauma 1990;30:56–9.CrossRefGoogle Scholar
  29. 29.
    Vaughan GM, Becker RA, Allen JP, et al. Cortisol and corticotropin in burned patients. J Trauma 1982;22:263–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Ziegler MG, Morrisey EC, Marshall LF. Catecholamine and thyroid hormones in traumatic injury. Crit Care Med 1990;18:253–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Shamoon H, Hendler R, Sherwin RS. Synergistic interactions among anti-insulin hormones in the pathogenesis of stress hyperglycemia in humans. J Clin Endocrinol Metab 1981;52:1235–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Weissman C. The metabolic response to stress: an overview and update. Anaesthesia 1990;73:308–27.CrossRefGoogle Scholar
  33. 33.
    Vaughan GM, Becker RA, Unger RH, et al. Non-thyroidal control of metabolism after burn injury-possible role of glucagon. Metabolism 1985; 34:637–41.PubMedCrossRefGoogle Scholar
  34. 34.
    Wilmore DW, Lindsey CA, Moylan JA, et al. Hyperglucagonemia after burns. Lancet 1974;1:73–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Russell RCG, Walker CJ, Bloom SR. Hyperglucagonemia in the surgical patient. Br Med J 1975;1:10–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Bessey PQ, Watters JM, Aoki TT, et al. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg 1984;200:264.PubMedCrossRefGoogle Scholar
  37. 37.
    Kalsner S. Mechanism of hydrocortisone potentiation of responses to epinephrine and nor-epinephrine in rabbit aorta. Circ Res 1969;24:383–95.PubMedCrossRefGoogle Scholar
  38. 38.
    Fraser CM, Patter PC, Chung FZ, et al. Glucocorticoid regulation of human lung beta-adrenergic receptor density occurs at the level of gene transcription. Fed Proc 1987;46:1463.Google Scholar
  39. 39.
    Newsholme EA, Crabtree B. Substrate cycles in metabolic regulation and in heat generation. Biochem Soc Symp 1976;41:61–109.PubMedGoogle Scholar
  40. 40.
    Wilmore DW, Aulick LH, Mason AD Jr, et al. Influence of burn wound on local and systemic responses to injury. Ann Surg 1977;186:44–8.CrossRefGoogle Scholar
  41. 41.
    Im MJC, Hoops JE. Energy metabolism in healing skin wounds. J Surg Res 1979;10:459–65.CrossRefGoogle Scholar
  42. 42.
    Falcone PA, Caldwell MD. Wound metabolism. Clin Plast Surg 1990;17: 443–56.PubMedGoogle Scholar
  43. 43.
    Long CL, Spencer JL, Kinney JM, Geiger JW. Carbohydrate metabolism in man: effect of elective operations and major injury. J Appl Physiol 1971; 31:110–6.PubMedGoogle Scholar
  44. 44.
    Harris RL, Frenkel RA, Cottam GL, Baxter CR. Lipid mobilization and metabolism after thermal injury. J Trauma 1982;22:194–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Wolfe RR, Goodenough RD, Burke JF, Wolfe MH. Response of protein and urea kinetics in burn patients to different levels of protein intake. Ann Surg 1983;197:163–71.PubMedCrossRefGoogle Scholar
  46. 46.
    Biolo G, Maggi SP, Fleming RYD, Herndon DN, Wolfe RR. Relationship between amino acid transport and protein kinetics in muscle tissue of severely burned patients. Am J Clin Nutr 1993;12:4–7.Google Scholar
  47. 47.
    Tessari P, Inchiostro S, Biolo G, et al. Differential effects of hyperinsulinemia and hyperaminoacidemia on leucine-carbon metabolism in vivo. J Clin Invest 1987;79:1062–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Jeffries MK, Vance ML. Growth hormone and cortisol secretion in patients with burn injury. J Burn Care Rehabil 1992;13:391–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Tanner JM, Hughes PCR, Whitehouse RH. Comparative rapidity of response of height, limb muscle and limb fat to treatment with human growth hormone in patients with and without growth hormone deficiency. Acta Endocrinol (Copenh) 1977;84:681–96.Google Scholar
  50. 50.
    Cheek DB, Hill DE. Muscle and liver cell growth: role of hormone and nutritional factors. Fed Proc 1970;29:1503–9.PubMedGoogle Scholar
  51. 51.
    Liljadahl SO, Gemzell CA, Plantin LO, et al. Effect of human growth hormone in patients with severe burns. Acta Chir Scand 1961;122:1–4.Google Scholar
  52. 52.
    Rudman D, Feller AG, Nagraj HS, et al. Effect of human growth hormone in men over 60 years old. N Engl J Med 1990;323:1–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Marcus R, Butterfield G, Holloway L, et al. Effects of short-term administration of recombinant human growth hormone to elderly people. J Clin Endocrinol Metab 1990;70:519–27.PubMedCrossRefGoogle Scholar
  54. 54.
    Manson JM, Wilmore DW. Positive nitrogen balance with human growth hormone and hypocaloric intravenous feeding. Surgery 1986;100:188–97.PubMedGoogle Scholar
  55. 55.
    Wilmore DW, Maylan JA, Bristow BF, et al. Anabolic effects of growth hormone and high caloric feedings following thermal injury. Surg Gynecol Obstet 1974;138:875–84.PubMedGoogle Scholar
  56. 56.
    Kostyo JL. Rapid effects of growth hormone on amino acid transport and protein synthesis. Ann NY Acad Sci 1968;148:389–407.PubMedCrossRefGoogle Scholar
  57. 57.
    Albertsson-Wikland K, Eden S, Ahren K, et al. Analysis of refractoriness to the effects of growth hormone on amino acid transport and protein synthesis in diaphragms of young normal rats. Endocrinology 1980;106:298–305.PubMedCrossRefGoogle Scholar
  58. 58.
    Yarasheski KE, Campbell JA, Rennie MK, et al. Effect of strength training and growth hormone administration on whole-body and skeletal muscle leucine metabolism. Med Sci Sports Exerc 1990;22:505A.Google Scholar
  59. 59.
    Horber FF, Haymond MW. Human growth hormone prevents the protein catabolic side effects of prednisone in humans. J Clin Invest 1990;86: 265–72.PubMedCrossRefGoogle Scholar
  60. 60.
    Fryburg DA, Gelfand RA, Barrett EJ. Growth hormone acutely stimulates forearm muscle protein synthesis in normal humans. Am J Physiol 1991;260: E499–504.PubMedGoogle Scholar
  61. 61.
    Wolf RF, Heslin MJ, Newman E, et al. Growth hormone and insulin combine to improve whole-body and skeletal muscle protein kinetics. Surgery 1992;112:284–92.PubMedGoogle Scholar
  62. 62.
    Gore DC, Honeycutt D, Jahoor F, et al. Effect of exogenous growth hormone on whole-body and isolated limb protein kinetics in burned patients. Arch Surg 1991;126:38–43.PubMedCrossRefGoogle Scholar
  63. 63.
    Jacob R, Barrett E, Plewe G, et al. Acute effects of insulin-like growth factor-I on glucose and amino acid metabolism in the awake fasted rat. J Clin Invest 1989;83:1717–23.PubMedCrossRefGoogle Scholar
  64. 64.
    Kupfer SR, Underwood LE, Baxter RC, et al. Enhancement of the anabolic effects of growth hormone and insulin-like growth factor I by use of both agents simultaneously. J Clin Invest 1993;91:391–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Clemmons DR, Smith-Banks A, Underwood LE. Reversal of diet-induced catabolism by infusion of recombinant insulin-like growth factor (IGF-1) in humans. J Clin Endocrinol Metab 1992;75:234–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Boulware SD, Tamborlane WV, Matthews LS, et al. Diverse effects of insulin-like growth factor I on glucose, lipid and amino acid metabolism. Am J Physiol 1992;262:E130–3.PubMedGoogle Scholar
  67. 67.
    Fukagawa NK, Minaker KL, Good WR, et al. Acute effects of insulin-like growth factor (IGF) on leucine (L). Diabetes 1990;38(suppl 1):12A.Google Scholar
  68. 68.
    Guler HP, Zapf J, Froesch ER. Short-term metabolic effects of recombinant human insulin-like growth factor I in healthy adults. N Engl J Med 1987;317: 137–40.PubMedCrossRefGoogle Scholar
  69. 69.
    Walker JL, Malinowska MG, Romer T, et al. Effects of the infusion of insulin-like growth factor in a child with growth hormone insensitivity syndrome (Laron dwarfism). N Engl J Med 1991;324:1483–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Wang C-Z, Barrow RE, Evans MJ, et al. Retinol and insulin-like growth factor-1 accelerate tracheal epithelium repair in sheep. 78th Surg Clin Cong 1992:659–61.Google Scholar
  71. 71.
    Tavakkol A, Elder JT, Griffiths CEM, et al. Expression of growth hormone receptor, insulin-like growth factor 1 (IGF-1) and IGF-1 receptor mRNA and proteins in human skin. J Invest Dermatol 1992;99:343–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Herndon DN, Barrow RE, Kunkel KR, et al. Effects of recombinant human growth hormone on donor-site healing time in severely burned children. Ann Surg 1990;212:424–31.PubMedCrossRefGoogle Scholar
  73. 73.
    Gilpin DA, Barrow RE, Rutan RL, et al. Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. Ann Surg 1994;220:19–24.PubMedCrossRefGoogle Scholar
  74. 74.
    Gore DC, Honeycutt D, Jahoor F, et al. Effect of exogenous growth hormone on glucose utilization in burn patients. J Surg Res 1991;51:518–23.PubMedCrossRefGoogle Scholar
  75. 75.
    Fleming RYD, Rutan RL, Jahoor F, et al. Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury. J Trauma 1992;32:698–703.PubMedCrossRefGoogle Scholar
  76. 76.
    Rowe JW, Young JB, Minaker KL, et al. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 1981;30:219–25.PubMedGoogle Scholar
  77. 77.
    Rutan RL, Herndon DN. Growth delay in postburn pediatric patients. Arch Surg 1990;125:392–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Klein GL, Herndon DN, Rutan TC, et al. Bone disease in burn patients. J Bone Miner Res 1993;8:337–45.PubMedCrossRefGoogle Scholar
  79. 79.
    Bruno LP, Stern PJ, Wyrick JD. Skeletal changes after burn injuries in an animal model. J Burn Care Rehabil 1988;9:148–51.PubMedCrossRefGoogle Scholar
  80. 80.
    Prader A. Catch-up growth. Postgrad Med J 1978;54(suppl):133–46.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Michael J. Muller
  • Thomas C. Rutan
  • David N. Herndon

There are no affiliations available

Personalised recommendations