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Growth hormone/insulin-like growth factors axis in children undergoing cardiac surgery
1Department of Pediatric Intensive Care, Hospital Materno-Infantil Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Insights
Children after cardiac surgery exhibit growth hormone (GH) resistance, with elevated GH but low insulin-like growth factor-I (IGF-I). This hormonal state may contribute to their catabolism.
Area of Science:
- Pediatric Endocrinology
- Pediatric Critical Care Medicine
- Surgical Metabolism
Background:
- Cardiac surgery in children can induce significant physiological stress.
- The growth hormone (GH)/insulin-like growth factors (IGF) axis plays a crucial role in metabolism and growth.
- Understanding hormonal changes post-cardiac surgery is vital for managing patient recovery.
Purpose of the Study:
- To investigate the sequential changes in the GH/IGF axis in children after cardiac surgery.
- To examine the relationship between these hormonal changes and nitrogen balance.
- To assess the stress response and catabolic state in this patient population.
Main Methods:
- Prospective descriptive study in a pediatric intensive care unit.
- Inclusion of 23 pediatric patients undergoing cardiac surgery with bypass.
- Collection of blood and urine samples on days 1, 2, and 7 post-admission, plus a pre-surgery sample.
Main Results:
- Elevated urinary growth hormone (GH) and cortisol (UFC) indicated stress.
- Low plasma insulin-like growth factor-I (IGF-I) and GH binding protein (GHBP) persisted post-surgery.
- Negative nitrogen balance and elevated urinary nitrogen urea excretion suggested a catabolic state, unrelated to IGF-I or nutritional markers.
Conclusions:
- Children post-cardiac surgery demonstrate a GH-resistant state.
- Elevated GH secretion is not accompanied by increased IGF-I or IGFBP-3, potentially promoting catabolism.
- IGF-I and its binding proteins (IGFBP-1, IGFBP-3) did not correlate with nitrogen balance or urea excretion.
Objectives:
To describe the sequential changes in the growth hormone (GH)/insulin-like growth factors axis and their relationship with nitrogen balance in children following cardiac surgery.
Design:
Prospective, descriptive study.
Setting:
Pediatric intensive care unit of a university hospital.
Patients:
Twenty three postoperative cardiac surgical patients after bypass.
Interventions:
Blood and urine samples were taken on days 1, 2, and 7 of pediatric intensive care unit admission. An intraanesthesia, presurgery sample was also obtained.
Measurements And Main Results:
Serum concentrations of insulin, insulin growth factor-I (IGF-I), insulin growth factor binding proteins 1 and 3 (IGFBP-1 and IGFBP-3), growth hormone binding protein (GHBP), and urinary concentrations of GH and free cortisol (UFC) were measured on days 1, 2, and 7 of the study period. C-reactive protein and prealbumin, were also measured in blood samples as conventional markers of inflammatory or nutritional status. Pediatric Risk of Mortality II score and UFC were used as indicators of acute stress. The nitrogen balance and urinary nitrogen urea excretion were used as markers of catabolic state. Urinary concentrations of GH were high from days 1 to 7. Plasma concentrations of IGF-I and GHBP were low and remained low throughout the study period. IGFBP-3 levels were below normal but without reaching statistical significance. The IGFBP-1 levels were initially high but descended progressively toward normal values. Urinary nitrogen urea production was persistently elevated and was associated with a negative nitrogen balance. No relationship was found between nitrogen balance and IGF-I, prealbumin, or C-reactive protein.
Conclusions:
A GH-resistant state is observed in postoperative children following cardiac surgery. Stress response is characterized by an elevation of growth hormone secretion that is not followed by the corresponding increment in IGF-I and IGFBP-3 concentrations. These hormonal changes may be permissive for the catabolic state of these patients. IGF-I and IGFBP-1 and -3 are not related to either nitrogen balance or urinary nitrogen urea excretion.
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