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Background. Circulating growth hormone (GH) levels in normal persons fluctuate widely because
of pulsatile GH secretion. It is not known whether this pulsatile nature and rhythmicity
exist in severe injury. These data become necessary to decide the timing of supplementary
GH administration for its optimal utilization. The purpose of this study was to investigate
the GH circadian variation with respect to that of insulin-like growth factor-1 (IGF-1),
insulin, C-peptide, and cortisol in the early flow phase of injury.
Methods. Plasma GH, IGF-1, insulin, C-peptide, and cortisol levels were measured at 1-hour
intervals during 24 hours (8 am to 8 am) in 10 severely injured adults with multiple trauma during the early catabolic flow
phase 24 to 48 hours after injury, when patients received maintenance fluids without
calories or nitrogen.
Results. The 24-hour integrated GH concentration is not different from either 12-hour mean
diurnal or 12-hour mean nocturnal or mean 8 am GH concentration. Pulsatile GH bursts persist in injured patients during both day
and night. Pulsatile bursts do not exist for IGF-1, insulin, and C-peptide. The plasma
levels of cortisol show time-dependent daily maximum and minimum levels.
Conclusions. Pulsatile GH bursts persist in injured patients but less frequently than seen in
normal persons. The time of bolus administration of GH to augment the anabolic GH
action in patients with trauma does not matter; however, for convenience morning administration
may be preferable for patients in the intensive care unit.
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Article info
Publication history
Accepted:
August 29,
1994
Footnotes
*Supported in part by a grant (no. 82-2688) from the Arizona Disease Control Research Commission.
*Presented at the annual meeting of the Arizona Chapter of the American College of Surgeons Committee on Trauma, Tucson, Ariz., Nov. 5–7, 1993.
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
