Growth hormone secretion in critical illness: effect of dopamine.

The catabolic state is a major contributor to the morbidity and mortality of critical illness. The underlying mechanism is poorly understood. We examined the endogenous secretion of an anabolic protein, GH, and studied the effect exerted on its secretion by dopamine, a catecholamine that is frequently administered for cardiovascular purposes in critical care. In a randomized controlled study of critically ill adult polytrauma patients (n = 11), we evaluated the effect of prolonged (83- to 296-h) dopamine infusion (5 micrograms/kg.min, iv) on the dynamics of GH secretion and on serum insulin-like growth factor-I, cortisol, and insulin concentrations. The effect of brief (15- to 21-h) dopamine administration was documented in an additional randomized controlled cross-over study involving nine patients. The GH profiles, obtained by blood sampling every 20 min for 9 h during 2 consecutive nights, were examined by deconvolution analysis. GH release was found to be exclusively pulsatile in all patients. Prolonged and brief dopamine infusions appeared to have similar effects. Twenty-four hours before initiation or after withdrawal of dopamine infusion, mean serum GH concentrations, mean secretion rate, amount of GH per secretory burst, and secretory burst amplitude were low, but, respectively, a median of 17% (P = 0.028), 36% (P = 0.046), 40% (P = 0.008), and 94% (P = 0.002) higher than those during dopamine infusion. After dopamine withdrawal, increased GH secretion was detectable within 3 h. Dopamine's effect on GH release was specific, as this agent had no discernable effect on the elevated serum cortisol and insulin concentrations or the low plasma insulin-like growth factor-I levels within 24 h. In conclusion, the present data suggest that pulsatile GH secretion is low during critical illness and that dopamine infusion further attenuates GH secretion through amplitude modulation, possibly as a result of a direct inhibitory action on the somatotropes. The latter iatrogenic effect might further aggravate the catabolic state of critical illness.

[1]  G. Van den Berghe,et al.  DOPAMINE AND THE EUTHYROID SICK SYNDROME IN CRITICAL ILLNESS , 1995 .

[2]  F. Zegher,et al.  Dopamine and the sick euthyroid syndrome in critical illness , 1994, Clinical endocrinology.

[3]  G. Verleden,et al.  Growth hormone as a rescue treatment after heart-lung or double-lung transplantation , 1994 .

[4]  J. Veldhuis,et al.  Dopamine Inhibits Growth Hormone and Prolactin Secretion in the Human Newborn , 1993, Pediatric Research.

[5]  R. Baxter,et al.  Enhancement of the anabolic effects of growth hormone and insulin-like growth factor I by use of both agents simultaneously. , 1993, The Journal of clinical investigation.

[6]  Kaplan Sl.  The newer uses of growth hormone in adults , 1993 .

[7]  J. Nauta,et al.  Pulsatile hormone secretion during severe sepsis: accuracy of different blood sampling regimens. , 1992, Metabolism: clinical and experimental.

[8]  J. Verhaeghe,et al.  The effects of systemic insulin, insulin-like growth factor-I and growth hormone on bone growth and turnover in spontaneously diabetic BB rats. , 1992, The Journal of endocrinology.

[9]  K. Alberti,et al.  Augmented growth hormone (GH) secretory burst frequency and amplitude mediate enhanced GH secretion during a two-day fast in normal men. , 1992, The Journal of clinical endocrinology and metabolism.

[10]  D. Johnston,et al.  Dopamine, the dopamine D2 receptor and pituitary tumours , 1991, Clinical endocrinology.

[11]  J. Holly,et al.  Levels of GH binding activity, IGFBP‐1, insulin, blood glucose and cortisol in intensive care patients , 1991, Clinical endocrinology.

[12]  D. Wilmore.  Catabolic illness. Strategies for enhancing recovery. , 1991, The New England journal of medicine.

[13]  F. Horber,et al.  Human growth hormone prevents the protein catabolic side effects of prednisone in humans. , 1990, The Journal of clinical investigation.

[14]  M. Fisher,et al.  What Rate of Infusion of Intravenous Nutrition Solution Is Required to Stimulate Uptake of Amino Acids by Peripheral Tissues in Depleted Patients? , 1990, Annals of surgery.

[15]  M. Vance,et al.  Half-time of endogenous growth hormone (GH) disappearance in normal man after stimulation of GH secretion by GH-releasing hormone and suppression with somatostatin. , 1989, The Journal of clinical endocrinology and metabolism.

[16]  M L Johnson,et al.  The pituitary gland secretes in bursts: appraising the nature of glandular secretory impulses by simultaneous multiple-parameter deconvolution of plasma hormone concentrations. , 1987, Proceedings of the National Academy of Sciences of the United States of America.

[17]  M. Vance,et al.  Role of dopamine in the regulation of growth hormone secretion: dopamine and bromocriptine augment growth hormone (GH)-releasing hormone-stimulated GH secretion in normal man. , 1987, The Journal of clinical endocrinology and metabolism.

[18]  D. Clemmons,et al.  Growth hormone administration conserves lean body mass during dietary restriction in obese subjects. , 1987, The Journal of clinical endocrinology and metabolism.

[19]  A. Vermeulen.  Nyctohemeral growth hormone profiles in young and aged men: correlation with somatomedin-C levels. , 1987, The Journal of clinical endocrinology and metabolism.

[20]  A. Beddoe,et al.  Aggressive nutritional support does not prevent protein loss despite fat gain in septic intensive care patients. , 1987, The Journal of trauma.

[21]  S. Melmed,et al.  Effects of Insulin on Rat Anterior Pituitary Cells: Inhibition of Growth Hormone Secretion and mRNA Levels , 1986, Diabetes.

[22]  Kinney Jm,et al.  Protein metabolism in the traumatized patient. , 1985 .

[23]  J. Jansson,et al.  Effect of frequency of growth hormone administration on longitudinal bone growth and body weight in hypophysectomized rats. , 1982, Acta physiologica Scandinavica.

[24]  C. Goodyer,et al.  Comparative study of human fetal, normal adult, and somatotropic adenoma pituitary function in tissue culture. , 1982, The Journal of clinical endocrinology and metabolism.

[25]  J. Ekstrand,et al.  Dopamine Infusion in Man. Plasma Catecholamine Levels and Pharmacokinetics , 1981, Acta anaesthesiologica Scandinavica.

[26]  R L Hintz,et al.  Somatomedin-C mediates growth hormone negative feedback by effects on both the hypothalamus and the pituitary. , 1981, Science.

[27]  S. Eden.  Age- and sex-related differences in episodic growth hormone secretion in the rat. , 1979, Endocrinology.

[28]  C. H. Mortimer,et al.  Bromocriptine treatment of acromegaly. , 1975, British medical journal.

[29]  P. D. de Moor,et al.  Heterogeneity of human growth hormone in serum. , 1974, Annales d'endocrinologie.