The combined administration of GH-releasing peptide-2 (GHRP-2), TRH and GnRH to men with prolonged critical illness evokes superior endocrine and metabolic effects compared to treatment with GHRP-2 alone.

Autor: Van den Berghe, Greet, Baxter, Robert C, Weekers, Frank, Wouters, Pieter, Bowers, Cyril Y, Iranmanesh, Ali, Veldhuis, Johannes D, Bouillon, Roger
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Zdroj: Clinical Endocrinology; May2002, Vol. 56 Issue 5, p655-669, 15p
Abstrakt: Summary objective Central hyposomatotrophism, hypothyroidism and hypogonadism are present concomitantly in men with prolonged critical illness. This study evaluated the impact of combined treatment with GH-releasing peptide-2 (GHRP-2), TRH and GnRH for 5 days compared with GHRP-2 + TRH and with GHRP-2 alone. patients and design Thirty-three men with prolonged critical illness participated at baseline compared to 50 age- and body mass index (BMI)-matched controls. Patients were randomly assigned to 5 days of placebo (n = 7), GHRP-2 (1 µg/kg/h; n = 9), GHRP-2 + TRH infusion (1 + 1 µg/kg/h; n = 9) or pulsatile GnRH (0·1 µg/kg every 90 min) together with GHRP-2 + TRH infusion (n = 8). measurements GH, TSH and LH secretion were quantified by deconvolution analysis of serum concentration time series obtained by sampling every 20 min from 2100 to 0600 h at baseline and on nights 1 and 5 of treatment. Serum concentrations of IGF-I, IGFBPs, thyroid hormones, gonadal and adrenal steroids, proinflammatory cytokines and selected metabolic and inflammation markers were measured daily. results Patients revealed suppressed pulsatile GH, TSH and LH secretion in the face of low serum concentrations of IGF-I, IGFBP-3 and the acid-labile subunit (ALS) (P < 0·0001 each), thyroid hormones (P < 0·0001) and total and estimated free testosterone (P < 0·0001) levels, whereas free oestradiol (E2) estimates were normal. Serum dehydroepiandrosterone sulphate (DHEAS) levels were also suppressed whereas morning cortisol was normal. Serum levels of type I procollagen (PICP) and bone alkaline phosphatase (sALP) were elevated whereas osteocalcin (OC) was low (P = 0·03). Ureagenesis (P < 0·0001) and breakdown of bone tissue (P < 0·0001) were increased. Baseline serum TNF-α, IL-6 and C-reactive protein level and white blood cell (WBC) count were elevated; serum lactate was normal. Only low T4 and high IGFBP-1 levels independently predicted... [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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