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Early hormonal changes affect the catabolic response to trauma

P Q Bessey1, K A Lowe

  • 1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

Annals of Surgery
|October 1, 1993
PubMed
Summary

Temporary insulin suppression during stress hormone increases amplifies nitrogen loss and accelerates muscle protein breakdown. Early hormonal changes after injury can influence later catabolic responses, impacting patient recovery.

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Area of Science:

  • Endocrinology
  • Metabolic Research
  • Physiology

Background:

  • Metabolic response to injury involves hypermetabolism, muscle protein breakdown, and insulin resistance, linked to elevated stress hormones.
  • Insulin levels typically decrease initially post-injury but rise during recovery.
  • Infusing stress hormones (hydrocortisone, glucagon, epinephrine) mimics critical illness metabolic changes but doesn't increase muscle breakdown.

Purpose of the Study:

  • To investigate the impact of temporary insulin suppression on the catabolic effects of stress hormones.
  • To understand how modulating insulin levels affects metabolic responses during simulated injury conditions.

Main Methods:

  • Seven healthy adults underwent a 3-day infusion of stress hormones (cortisol, glucagon, epinephrine) in two conditions.

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  • One condition involved temporary insulin suppression using octreotide for the first 24 hours.
  • The control condition allowed insulin levels to rise naturally.

    • Main Results:

    • Stress hormone levels, hypermetabolism, and leukocytosis remained consistent across both study periods.
    • Temporary insulin suppression significantly increased whole-body nitrogen loss within 48 hours.
    • Amino acid efflux from forearm tissue was 60% higher after 72 hours of insulin suppression compared to control.

    Conclusions:

    • Temporarily suppressing insulin during elevated stress hormone levels exacerbates nitrogen loss and promotes skeletal muscle protein breakdown.
    • These findings suggest that early hormonal shifts post-injury can influence the progression of catabolic states.
    • Modulating insulin availability early in critical illness may be crucial for mitigating muscle wasting.